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Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients

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Abstract

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) is an emergent pathogen in healthcare-associated infections (HAIs). The aim of this study was to describe HAIs due to KPC-Kp, as well as identify mortality risk factors in cancer patients. In patients diagnosed with HAIs due to KPC-Kp between January 2009 and July 2013, we evaluated only the first infection episode of each patient, analyzing mortality separately for patients treated for ≥48 h with at least one antimicrobial agent proven to display in vitro activity against KPC-Kp. We evaluated variables related to the malignancy, the severity and characteristics of the HAI, and the antimicrobial therapy. We identified 83 HAIs due to KPC-Kp. The 30-day mortality was 57.8 % for all infections and 72.7 % for bacteremic infections. Of the 83 patients, 60 patients received ≥48 h of appropriate treatment and 44 (53 %) developed bacteremia. Ten patients (12 %) were neutropenic at HAI diagnosis and 33 (39.8 %) had infection at the tumor site. The most common HAI was urinary tract infection, seen in 26 patients (31.3 %), followed by primary bloodstream infection, seen in 24 patients (28.9 %). Forty-four patients (73.3 %) received combination antimicrobial therapy, most often including polymyxin (68.3 %). Risk factors for 30-day mortality are high sequential organ failure assessment (SOFA) score, need for intensive care stay at diagnosis of infection, and acute kidney injury; the removal of invasive devices related to infection and treatment with effective antibiotics for KPC-Kp are protective factors. In cancer patients, high mortality is associated with HAI due to KPC-Kp and mortality risk factors are more often related to acute infection than to the underlying disease.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 01246-000, Brazil

    M. P. Freire, L. C. Pierrotti, K. Y. Ibrahim, A. S. G. K. Magri, P. R. Bonazzi & E. Abdala

  2. Division of Molecular Biology, Central Laboratory, Laboratório de Investigação Médica 03 (LIM-03, Laboratory for Medical Research 03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, 01246-903, Brazil

    H. H. C. Filho & P. M. Hoff

  3. Intensive Care Service, Instituto do Câncer do Estado de São Paulo, Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 01246-000, Brazil

    L. Hajar

  4. Service of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 01246-000, Brazil

    M. P. E. Diz & P. M. Hoff

  5. Service of Hematology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 01246-000, Brazil

    J. Pereira

  6. Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 01246-903, Brazil

    E. Abdala

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  1. M. P. Freire
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  2. L. C. Pierrotti
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  3. H. H. C. Filho
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  10. P. M. Hoff
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Freire, M.P., Pierrotti, L.C., Filho, H.H.C. et al. Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients. Eur J Clin Microbiol Infect Dis 34, 277–286 (2015). https://doi.org/10.1007/s10096-014-2233-5

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