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Table 1 Demographic and clinical characteristics of the study cohort

From: Clinical and epidemiological characteristics of KPC-producing Klebsiella pneumoniae from bloodstream infections in a tertiary referral center in Italy

Variables 30-days outcome
All, 112 Death, 39 (35%) Survive, 73 (65%) p-value
Patients variables
 Sex
  • Male 80 (72%) 27 (69%) 53 (73%) 0.875
  • Female 32 (28%) 12 (31%) 20 (27%)
 Age (years) median (IQR) 68 (55–76) 72 (58–78) 65 (54–75) 0.528
 Charlsons Comorbidity Index ≥3 93 (83%) 37 (95%) 56 (77%) 0.030
 Comorbidities
  • Diabetes 31 (28%) 9 (23%) 22 (30%) 0.566
  • COPD 18 (16%) 7 (18%) 11 (15%) 0.900
  • Haematological malignancies 16 (14%) 9 (23%) 7 (10%) 0.097
  • Solid tumors 37 (33%) 15 (39%) 22 (30%) 0.496
  • Chronic Hepatitis 10 (9%) 5 (13%) 5 (7%) 0.313
  • Cardiovascular disease 66 (54%) 23 (59%) 43 (59%) 0.994
  • Neurological disease 38 (34%) 6 (15%) 32 (44%) 0.005
  • Chronic kidney disease 32 (29%) 14 (36%) 18 (25%) 0.301
  • HIV 1 (1%) 0 1 (1%) 1.000
  • Neutropenia 12 (11%) 8 (21%) 4 (6%) 0.033
  • Gastrointestinal disease 23 (21%) 5 (13%) 18 (25%) 0.218
  • SOT 5 (5%) 3 (8%) 2 (3%) 0.226
  • Others 21 (19%) 5 (13%) 16 (22%) 0.357
 Apache II score ≥ 15 56 (50%) 32 (82%) 24 (33%) < 0.001
 Acute comorbidities
  • Septic shock 40 (36%) 26 (67%) 14 (19%) < 0.001
  • pneumonia 48 (43%) 21 (54%) 27 (37%) 0.129
  • Acute kidney failure 18 (16%) 8 (20%) 10 (14%) 0.506
  • Gastrointestinal perforation 5 (5%) 4 (10%) 1 (1%) 0.049
  • Trauma 10 (9%) 2 (5%) 8 (11%) 0.489
  • Others 53 (47%) 16 (41%) 37 (51%) 0.329
Hospitalization variables
 Nosocomial infection 104 (93%) 36 (92%) 68 (93%) 1.000
 Healthcare-related infectiona 8 (7%) 3 (8%) 5 (7%)
 Wards submitting index culture
  • Intensive care unit 45 (40%) 15 (38%) 30 (41%) 0.945
  • Surgery 27 (24%) 7 (18%) 20 (27%) 0.378
  • Medicine 32 (29%) 14 (36%) 18 (25%) 0.301
  • Other health care facilities 8 (7%) 3 (8%) 5 (7%) 1.000
 Time interval (days) from admission, median (IQR) 23,5 (11–39) 23,5 (11–39) 24,5 (11,5–39) 0.541
 Total previous hospitalization, median (IQR)b 30,5 (15–59.25) 33 (15–66) 27 (14.5–51.5) 0.352
Pre-infection variables
 Central venous catheter 99 (88%) 39 (100%) 60 (82%) 0.004
 Other devices 102 (91%) 38 (97%) 64 (88%) 0.161
 CVVH 8 (7%) 3 (8%) 5 (7%) 1.000
 Invasive proceduresc 31 (28%) 17 (44%) 14 (19%) 0.011
 Steroid therapyd 43 (38%) 18 (46%) 25 (34%) 0.303
 Immunosuppressive therapyd,e 29 (26%) 15 (39%) 14 (19%) 0.046
 Previous Surgeryf 60 (54%) 22 (56%) 51 (70%) 0.090
  • Gastrointestinal surgery 30 (27%) 11 (28%) 19 (26%) 0.981
  • Cardiovascular surgery 9 (8%) 5 (13%) 4 (6) 0.272
  • Urologic surgery 7 (6%) 3 (8%) 4 (6%) 0.693
  • Neurosurgery 13 (12%) 2 (5%) 11 (15%) 0.214
  • Orthopedic surgery 9 (8%) 1 (3%) 8 (11%) 0.158
  • Plastic surgery 3 (3%) 0 3 (4%) 0.550
  • Thoracic surgery 3 (3%) 1 (3%) 2 (3%) 1.000
Microbiologic variables
 KPC rectal swabg 32 (29%) 16 (41%) 16 (22%) 0.056
 Isolation of KPC from other sites
  • Urinary tract 30 (27%) 7 (18%) 23 (32%) 0.187
  • Bronchial / pleural fluid 36 (32%) 11 (28%) 25 (34%) 0.660
  • abdominal fluid 13 (9%) 6 (15%) 7 (10%) 0.370
  • wounds 15 (13%) 6 (15%) 9 (12%) 0.872
 Other infections, n° (%)
  • Previous infectionsh 35 (31%) 11 (28%) 24 (33%) 0.769
  • Concomitanti 26 (23%) 10 (26%) 16 (22%) 0.834
Treatment variables
 Previous antibiotic therapyd 91 (81%) 33 (85%) 58 (80%) 0.680
  • Penicillins 34 (30%) 12 (31%) 22 (30%) 1.000
  • Cephalosporins 8 (7%) 1 (3%) 7 (10%) 0.258
  • Carbapenems 51 (46%) 20 (51%) 31 (43%) 0.488
  • Fluoroquinolones 32 (29%) 12 (31%) 20 (27%) 0.875
  • Macrolides 4 (4%) 0 4 (6%) 0.296
  • Aminoglycosides 10 (9%) 1 (1%) 9 (12%) 0.161
  • Tigecycline 21 (19%) 8 (21%) 13 (18%) 0.924
  • Colistin 14 (13) 6 (15) 8 (11%) 0.708
  • Others 47 (42%) 19 (48%) 28 (38%) 0.391
 Adequate empiric antibiotic treatmentj 15 (13%) 6 (15%) 9 (12%) 0.872
 Post-antibiogram therapy
  • Colistin-including therapy 44 (39%) 11 (28%) 33 (45%) 0.121
  • Tigecycline-including therapy 57 (51%) 16 (41%) 41 (56%) 0.184
  • Gentamicin-including therapy 46 (41%) 9 (23%) 37 (51%) 0.009
  • Monotherapy 13 (12%) 3 (8%) 10 (14%) 0.537
  • Combination therapy 89 (80%) 29 (74%) 60 (82%) 0.328
  • Two-drug combinations 24 (21%) 10 (26%) 14 (19%) 0.581
  • Combinations with ≥ three drugs 66 (59%) 19 (49%) 47 (64%) 0.160
  • Carbapenem-excluding combinations 41 (37%) 16 (41%) 25 (34%) 0.615
  • Carbapenem-including combinations 71 (63%) 23 (59%) 48 (66%)
  • Double-carbapenem combinations 5 (5%) 2 (5%) 3 (4%) 1.000
  • Rifampin addition to combination 3 (3%) 2 (5%) 1 (1%) 0.240
  • Adequate antibiotic treatmentj 84 (74%) 21 (54%) 63 (85%) < 0.001
   -with one active drug 49 (44%) 17 (44%) 32 (44%) 1.000
   -with two or three active drugs 35 (31%) 4 (10%) 31 (42%) < 0.001
KPC-K isolate characteristics
 Colistin resistant 66 (59%) 22 (56%) 44 (60%) 0.846
 Tigecycline resistantk 27 (37%) 10 (45%) 17 (33%) 0.436
 Gentamicin resistant 14 (13%) 5 (13%) 9 (12%) 1.000
 Amikacin resistant 97 (86%) 33 (85%) 64 (88%) 0.872
 Fosfomycin resistant 72 (64%) 19 (49%) 53 (73%) 0.188
 Bactrim resistant 92 (82%) 30 (77%) 62 (85%) 0.426
 Meropenem MIC ≤8 4 (4%) 3 (8%) 1 (1%) 0.086
 Meropenem MIC≥16 108 (96%) 36 (87%) 72 (99%)
 Pulsotype A – ST512l 97 (91%) 33 (89%) 64 (91%) 0.705
 Pulsotype B – ST307l 10 (9%) 4 (11%) 6 (9%)
  1. Data are expressed as No. (%) unless otherwise specified
  2. Abbreviations: APACHE Acute Physiology and Chronic Health Evaluation, IQR interquartile range, COPD Chronic obstructive pulmonary disease, SOT solid organ transplantation, CVVH Continuous Veno-Venous Hemofiltration
  3. aHealthcare-associated infections are defined as described by Friedman, N. D. 2002. Health Care–Associated Bloodstream Infections in Adults: A Reason To Change the Accepted Definition of Community-Acquired Infections. Annals of Internal Medicine, 137 (10), 791. doi:https://doi.org/10.7326/0003-4819-137-10-200211190-00007
  4. bDuring the 12 months preceding BSI onset
  5. cDuring the 72 h preceding BSI onset
  6. dDuring the 30 days preceding BSI onset
  7. eExcluding therapy with steroids
  8. fDuring the 3 months preceding BSI onset
  9. gThe majority of rectal swabs was collected before the onset of KPC-Kp BSI, during of the same hospitalization
  10. hDuring the 30 days preceding BSI onset. Previous infections included: lung infections (n = 16), BSIs (n = 5), SSTIs (n = 3), CNS infections (n = 2), abdominal infections (n = 2), UTIs (n = 2), abdominal infection plus BSI (n = 1), UTI plus BSI (n = 1), lung infection plus BSI (n = 1), lung infection plus SSTI (n = 1), lung infection plus UTI (n = 1)
  11. iConcomitant infections included lung infections (n = 8), BSIs (n = 4), UTIs (n = 4), SSTIs (n = 2), abdominal infection (n = 1), BSIs plus lung infections (n = 3), BSI plus lung infection plus CNS infection plus SSTI (n = 1), abdominal infection plus BSI (n = 1), lung infection plus UTI (n = 1) and BSI plus UTI (n = 1). 10 BSI were polymicrobial
  12. jAdequate therapy is defined as the use of at least one drugs to which the isolate was susceptible in vitro
  13. kStrains showing tigecycline MIC ≥4 mg/L were considered non susceptible as stated by Marchaim et al. 2014. Major variation in MICs of tigecycline in Gram-negative bacilli as a function of testing method. J Clin Microbiol, 52:1617–21. doi:https://doi.org/10.1128/JCM.00001-14
  14. lPercentage of these variables are calculated only on the 107 patients from which bacterial strains were recovered