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Clinical and Microbiological Risk Factors for 30-Day Mortality of Bloodstream Infections Caused by OXA-48-Producing
Pilar Lumbreras-Iglesias1,2,3, Edurne Rodrigo-Arrazola2, Lucía López-Amor4
1Traslational Microbiology Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain.
Abstract:
Bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae are associated with high morbidity and mortality, and the therapy options available for their treatment are frequently scarce. The aim of this study was to analyze risk factors for 30-day mortality in patients with BSI caused by OXA-48-producing K. pneumoniae. The clinical and treatment features of the patients, who attended a single hospital over a five-year period, were retrospectively reviewed. The microbiological features, including the sequence types (ST) and the somatic (O) and capsular (K) antigens, as well as their resistance properties, comprising phenotypes and genetic background, were also considered. To identify the risk factors for 30-day mortality, uni- and multivariate statistical analyses were performed. The univariate analysis revealed statistically significant correlations for age, male gender, lower respiratory system infection, infection by ST147 isolates, and infection by isolates expressing the K64 antigen. The multivariate analysis, applied to variables yielding p-values close to or lower than 0.05 in the univariate analysis, confirmed gender, lower respiratory system infection, and infection with ST147 isolates, but not age or infection with K64 isolates, as risk factors for 30-day mortality. Moreover, the multivariate analysis showed that patients suffering from hematological malignancies or having been treated with inappropriate therapy, both having p-values slightly higher than 0.05 in the univariate analysis, exhibited significantly poorer outcomes in the multivariant analysis. The association of the ST147 clone with an increased risk of mortality is a novel finding that deserves further attention. Studies like the one presented here can certainly benefit the management of patients with nosocomial BSI caused by carbapenemase-producing K. pneumoniae.
Insights
Bloodstream infections (BSI) from carbapenem-resistant Klebsiella pneumoniae pose a high mortality risk. Male gender, lower respiratory infections, and ST147 isolates are key risk factors for 30-day mortality in these patients.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) present significant therapeutic challenges due to limited treatment options and high mortality rates.
- OXA-48-producing K. pneumoniae is a critical pathogen contributing to the burden of CRKP infections.
Purpose of the Study:
- To identify and analyze the risk factors associated with 30-day mortality in patients experiencing BSIs caused by OXA-48-producing K. pneumoniae.
Main Methods:
- Retrospective review of clinical and treatment data from patients with BSI caused by OXA-48-producing K. pneumoniae over a five-year period.
- Comprehensive microbiological analysis including sequence types (ST), O and K antigens, and antimicrobial resistance profiles.
- Application of univariate and multivariate statistical analyses to determine significant risk factors for 30-day mortality.
Main Results:
- Univariate analysis identified age, male gender, lower respiratory system infection, ST147 isolates, and K64 antigen expression as potential risk factors.
- Multivariate analysis confirmed male gender, lower respiratory system infection, and ST147 isolates as independent risk factors for 30-day mortality.
- Hematological malignancies and inappropriate initial therapy emerged as significant predictors of poorer outcomes in the multivariate analysis, despite borderline significance in univariate analysis.
Conclusions:
- Male gender, lower respiratory system infection, and infection with the ST147 clone are significant risk factors for 30-day mortality in patients with BSIs caused by OXA-48-producing K. pneumoniae.
- The association between the ST147 clone and increased mortality risk is a novel finding requiring further investigation.
- These findings can inform clinical management strategies for nosocomial BSIs caused by carbapenemase-producing K. pneumoniae.
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