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Colistin resistance increases 28-day mortality in bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae

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Abstract

Mortality due to K. pneumoniae bacteremia is on rise, particularly in regions with high rates of carbapenem and colistin resistance. We aimed to define risk factors for colistin resistance and its impact on mortality. Patients diagnosed with “carbapenem-resistant K. pneumoniae (CRKp)” bacteremia between 2014 and 2018 were divided into two groups as “colistin susceptible (ColS)” and “colistin resistant (ColR)” based on broth microdilution method. Retrospective case-control study was conducted to compare characteristics and outcomes. Multiple logistic regression model was used to define independent risk factors for acquired colistin resistance and Cox proportional hazard model for 28-day mortality. A total of 82 patients (39 ColS and 43 ColR) were included. Mean age was 61.5 years, and 50 (61%) were male. Colistin resistance was significantly increased with duration of hospital stay (p = 0.007) and prior colistin use (p = 0.007). Overall, the 28-day mortality rate was 66%. Age (p = 0.014) and colistin resistance significantly increased 28-day (p = 0.009) mortality. Microbiological response to treatment within 7 days favors survival. PFGE analysis revealed an outbreak with K. pneumoniae ST78 and ST45 clones. Patients treated with combined antimicrobials had significantly lower 28-day mortality (p = 0.045) in comparison to monotherapy. However, types of combinations did not show significant superiority on each other. Colistin resistance increases 28-day mortality in CRKp bacteremia. Although combined regimens are more effective than monotherapy, existing antibacterial combinations have no apparent superiority to each other. New treatment options are pivotal.

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Acknowledgments

We commemorate Nur Hondur with mercy and respect and express our sincere appreciations to Hatice Yaşar Arsu and Zeynep Alişan for their dedication to ensure that every work in the laboratory is carried out to the highest quality. Heartfelt thanks to Songül Gedik Koç for her extraordinary efforts to retrieve patient data. We are grateful to Prof. Recep Öztürk for establishing Infectious Diseases and Clinical Microbiology Laboratory and leading us in the field of research.

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Authors and Affiliations

  1. Istanbul Universitesi-Cerrahpasa, Cerrahpasa Faculty of Medicine, Cerrahpasa Tip Fakultesi, İstanbul, Turkey

    Ilker Inanc Balkan, Mustafa Alkan, Gökhan Aygün, Mert Kuşkucu, Handan Ankaralı, Alper Karagöz, Sümeyye Şen, Hatice Yaşar Arsu, Mehtap Biçer, Sibel Yıldız Kaya, Rıdvan Karaali, Bilgül Mete, Neşe Saltoğlu & Fehmi Tabak

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  1. Ilker Inanc Balkan
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Correspondence to Ilker Inanc Balkan.

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Conflict of interest

The authors declare that they have no conflict of interest. All laboratory materials used for colistin microdilution, PFGE and molecular tests were provided free of charge from relevant manufacturers and suppliers. Biostatistician of the study is a licensed user of the package program IBM spss ver. 22.

Ethical approval

The study was approved by Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty Ethics Committee on February 10, 2018, with an approval number of 83045809-604.01.02-A27. Since the study was based on the analysis of retrospective case data, the board did not require voluntary consent from patients or legal heirs retrospectively.

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Balkan, I.I., Alkan, M., Aygün, G. et al. Colistin resistance increases 28-day mortality in bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae. Eur J Clin Microbiol Infect Dis 40, 2161–2170 (2021). https://doi.org/10.1007/s10096-020-04124-y

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