Carbapenem-resistant Klebsiella pneumoniae bloodstream infections in haematological malignances and hematopoietic stem cell transplantation: Clinical impact of combination therapy in a 10-year Brazilian cohort

• DOI: 10.1371/journal.pone.0297161
• Publication Date: 2024-01-26T18:31:12Z
• Authors: Ingvar Ludwig Aug...; Paola Cappellano; Diogo Boldim Ferr...; Maria Daniela Ber...; Thomas Cardoso da...; Fabio Rodrigues K...; Otavio Carvalho G...; Antonio Carlos Ca...
• Keywords: Bacteremia

Bacterial bloodstream infections (BSI) are a common threat among patients with haematological malignancies (HM) and hematopoietic stem cell transplant recipients (HSCT). The purpose of this research was to describe clinical microbiological aspects BSI caused by carbapenem-resistant Klebsiella pneumoniae (CRKp) assess risk factors associated 30-day mortality in 10-year cohort patients. A total 65 CRKp-BSI episodes occurring HM HSCT between January 2010 December 2019 were retrospectively studied. Acute leukemias the most frequently observed underlying disease (87.7%) 18 (27.7%) received HSCT. Mucosal barrier injury gastrointestinal tract primary cause bacteremia (86.1%). Also, 14 individuals (21.6%) had an Invasive Fungal Disease (IFD) throughout episode. Regarding treatment, 31 (47.7%) empirical therapy deemed appropriate, whereas 33 (50.8%) combination therapy. Microbiological data revealed that majority isolates (53–58%) Polymyxin B co-resistance phenotype, while amikacin resistance less (16 samples, or 24.7%). rates at 30 days 32.3% 36.9%, respectively. In multivariate Cox regression analysis, prompt appropriate antibiotic administration within three better outcome (Adjusted Hazard Ratio [aHR]: 0.33; 95% Confidence Interval [CI]: 0.14–0.76; p = 0.01), hypotension presentation (aHR: 3.88; CI: 1.40–10.74; 0.01) concurrent IFD 2.97; 1.20–7.37; 0.02) independently death days. Additionally, favorable correlation overall survival found 0.18; 95%CI: 0.06–0.56; 0.002). conclusion, elevated polymyxin resistant. Early antimicrobial treatment use linked outcome.