The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients
Introduction Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons fo...
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| Autor*in: |
Maraolo, Alberto E. [verfasserIn] Corcione, Silvia [verfasserIn] Grossi, Adriano [verfasserIn] Signori, Alessio [verfasserIn] Alicino, Cristiano [verfasserIn] Hussein, Khetam [verfasserIn] Trecarichi, Enrico M. [verfasserIn] Viale, Pierluigi [verfasserIn] Timsit, Jean-François [verfasserIn] Veeraraghavan, Balaji [verfasserIn] Villegas, Maria V. [verfasserIn] Rahav, Galia [verfasserIn] Daikos, George L. [verfasserIn] Vardakas, Konstantinos Z. [verfasserIn] Roilides, Emmanuel [verfasserIn] Uhlemann, Anne-Catrin [verfasserIn] Ghafur, Abdul K. [verfasserIn] Mornese Pinna, Simone [verfasserIn] Bassetti, Matteo [verfasserIn] Kohler, Philipp P. [verfasserIn] Giacobbe, Daniele R. [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2021 |
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| Schlagwörter: |
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| Übergeordnetes Werk: |
Enthalten in: Infectious diseases and therapy - Heidelberg : Springer, 2012, 10(2021), 1 vom: 14. Feb., Seite 541-558 |
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| Übergeordnetes Werk: |
volume:10 ; year:2021 ; number:1 ; day:14 ; month:02 ; pages:541-558 |
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| DOI / URN: |
10.1007/s40121-021-00408-8 |
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| Katalog-ID: |
SPR043483712 |
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| 100 | 1 | |a Maraolo, Alberto E. |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients |
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| 520 | |a Introduction Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials. | ||
| 650 | 4 | |a Active therapy |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Carbapenem-resistant |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Individual patient data meta-analysis |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Monotherapy |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Corcione, Silvia |e verfasserin |4 aut | |
| 700 | 1 | |a Grossi, Adriano |e verfasserin |4 aut | |
| 700 | 1 | |a Signori, Alessio |e verfasserin |4 aut | |
| 700 | 1 | |a Alicino, Cristiano |e verfasserin |4 aut | |
| 700 | 1 | |a Hussein, Khetam |e verfasserin |4 aut | |
| 700 | 1 | |a Trecarichi, Enrico M. |e verfasserin |4 aut | |
| 700 | 1 | |a Viale, Pierluigi |e verfasserin |4 aut | |
| 700 | 1 | |a Timsit, Jean-François |e verfasserin |4 aut | |
| 700 | 1 | |a Veeraraghavan, Balaji |e verfasserin |4 aut | |
| 700 | 1 | |a Villegas, Maria V. |e verfasserin |4 aut | |
| 700 | 1 | |a Rahav, Galia |e verfasserin |4 aut | |
| 700 | 1 | |a Daikos, George L. |e verfasserin |4 aut | |
| 700 | 1 | |a Vardakas, Konstantinos Z. |e verfasserin |4 aut | |
| 700 | 1 | |a Roilides, Emmanuel |e verfasserin |4 aut | |
| 700 | 1 | |a Uhlemann, Anne-Catrin |e verfasserin |4 aut | |
| 700 | 1 | |a Ghafur, Abdul K. |e verfasserin |4 aut | |
| 700 | 1 | |a Mornese Pinna, Simone |e verfasserin |4 aut | |
| 700 | 1 | |a Bassetti, Matteo |e verfasserin |4 aut | |
| 700 | 1 | |a Kohler, Philipp P. |e verfasserin |4 aut | |
| 700 | 1 | |a Giacobbe, Daniele R. |e verfasserin |4 aut | |
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10.1007/s40121-021-00408-8 doi (DE-627)SPR043483712 (DE-599)SPRs40121-021-00408-8-e (SPR)s40121-021-00408-8-e DE-627 ger DE-627 rakwb eng 610 ASE Maraolo, Alberto E. verfasserin aut The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials. Active therapy (dpeaa)DE-He213 Carbapenem-resistant (dpeaa)DE-He213 Individual patient data meta-analysis (dpeaa)DE-He213 Monotherapy (dpeaa)DE-He213 Corcione, Silvia verfasserin aut Grossi, Adriano verfasserin aut Signori, Alessio verfasserin aut Alicino, Cristiano verfasserin aut Hussein, Khetam verfasserin aut Trecarichi, Enrico M. verfasserin aut Viale, Pierluigi verfasserin aut Timsit, Jean-François verfasserin aut Veeraraghavan, Balaji verfasserin aut Villegas, Maria V. verfasserin aut Rahav, Galia verfasserin aut Daikos, George L. verfasserin aut Vardakas, Konstantinos Z. verfasserin aut Roilides, Emmanuel verfasserin aut Uhlemann, Anne-Catrin verfasserin aut Ghafur, Abdul K. verfasserin aut Mornese Pinna, Simone verfasserin aut Bassetti, Matteo verfasserin aut Kohler, Philipp P. verfasserin aut Giacobbe, Daniele R. verfasserin aut Enthalten in Infectious diseases and therapy Heidelberg : Springer, 2012 10(2021), 1 vom: 14. Feb., Seite 541-558 (DE-627)735690766 (DE-600)2701611-0 2193-6382 nnns volume:10 year:2021 number:1 day:14 month:02 pages:541-558 https://dx.doi.org/10.1007/s40121-021-00408-8 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2021 1 14 02 541-558 |
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10.1007/s40121-021-00408-8 doi (DE-627)SPR043483712 (DE-599)SPRs40121-021-00408-8-e (SPR)s40121-021-00408-8-e DE-627 ger DE-627 rakwb eng 610 ASE Maraolo, Alberto E. verfasserin aut The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials. Active therapy (dpeaa)DE-He213 Carbapenem-resistant (dpeaa)DE-He213 Individual patient data meta-analysis (dpeaa)DE-He213 Monotherapy (dpeaa)DE-He213 Corcione, Silvia verfasserin aut Grossi, Adriano verfasserin aut Signori, Alessio verfasserin aut Alicino, Cristiano verfasserin aut Hussein, Khetam verfasserin aut Trecarichi, Enrico M. verfasserin aut Viale, Pierluigi verfasserin aut Timsit, Jean-François verfasserin aut Veeraraghavan, Balaji verfasserin aut Villegas, Maria V. verfasserin aut Rahav, Galia verfasserin aut Daikos, George L. verfasserin aut Vardakas, Konstantinos Z. verfasserin aut Roilides, Emmanuel verfasserin aut Uhlemann, Anne-Catrin verfasserin aut Ghafur, Abdul K. verfasserin aut Mornese Pinna, Simone verfasserin aut Bassetti, Matteo verfasserin aut Kohler, Philipp P. verfasserin aut Giacobbe, Daniele R. verfasserin aut Enthalten in Infectious diseases and therapy Heidelberg : Springer, 2012 10(2021), 1 vom: 14. Feb., Seite 541-558 (DE-627)735690766 (DE-600)2701611-0 2193-6382 nnns volume:10 year:2021 number:1 day:14 month:02 pages:541-558 https://dx.doi.org/10.1007/s40121-021-00408-8 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2021 1 14 02 541-558 |
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10.1007/s40121-021-00408-8 doi (DE-627)SPR043483712 (DE-599)SPRs40121-021-00408-8-e (SPR)s40121-021-00408-8-e DE-627 ger DE-627 rakwb eng 610 ASE Maraolo, Alberto E. verfasserin aut The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials. Active therapy (dpeaa)DE-He213 Carbapenem-resistant (dpeaa)DE-He213 Individual patient data meta-analysis (dpeaa)DE-He213 Monotherapy (dpeaa)DE-He213 Corcione, Silvia verfasserin aut Grossi, Adriano verfasserin aut Signori, Alessio verfasserin aut Alicino, Cristiano verfasserin aut Hussein, Khetam verfasserin aut Trecarichi, Enrico M. verfasserin aut Viale, Pierluigi verfasserin aut Timsit, Jean-François verfasserin aut Veeraraghavan, Balaji verfasserin aut Villegas, Maria V. verfasserin aut Rahav, Galia verfasserin aut Daikos, George L. verfasserin aut Vardakas, Konstantinos Z. verfasserin aut Roilides, Emmanuel verfasserin aut Uhlemann, Anne-Catrin verfasserin aut Ghafur, Abdul K. verfasserin aut Mornese Pinna, Simone verfasserin aut Bassetti, Matteo verfasserin aut Kohler, Philipp P. verfasserin aut Giacobbe, Daniele R. verfasserin aut Enthalten in Infectious diseases and therapy Heidelberg : Springer, 2012 10(2021), 1 vom: 14. Feb., Seite 541-558 (DE-627)735690766 (DE-600)2701611-0 2193-6382 nnns volume:10 year:2021 number:1 day:14 month:02 pages:541-558 https://dx.doi.org/10.1007/s40121-021-00408-8 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2021 1 14 02 541-558 |
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10.1007/s40121-021-00408-8 doi (DE-627)SPR043483712 (DE-599)SPRs40121-021-00408-8-e (SPR)s40121-021-00408-8-e DE-627 ger DE-627 rakwb eng 610 ASE Maraolo, Alberto E. verfasserin aut The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials. Active therapy (dpeaa)DE-He213 Carbapenem-resistant (dpeaa)DE-He213 Individual patient data meta-analysis (dpeaa)DE-He213 Monotherapy (dpeaa)DE-He213 Corcione, Silvia verfasserin aut Grossi, Adriano verfasserin aut Signori, Alessio verfasserin aut Alicino, Cristiano verfasserin aut Hussein, Khetam verfasserin aut Trecarichi, Enrico M. verfasserin aut Viale, Pierluigi verfasserin aut Timsit, Jean-François verfasserin aut Veeraraghavan, Balaji verfasserin aut Villegas, Maria V. verfasserin aut Rahav, Galia verfasserin aut Daikos, George L. verfasserin aut Vardakas, Konstantinos Z. verfasserin aut Roilides, Emmanuel verfasserin aut Uhlemann, Anne-Catrin verfasserin aut Ghafur, Abdul K. verfasserin aut Mornese Pinna, Simone verfasserin aut Bassetti, Matteo verfasserin aut Kohler, Philipp P. verfasserin aut Giacobbe, Daniele R. verfasserin aut Enthalten in Infectious diseases and therapy Heidelberg : Springer, 2012 10(2021), 1 vom: 14. Feb., Seite 541-558 (DE-627)735690766 (DE-600)2701611-0 2193-6382 nnns volume:10 year:2021 number:1 day:14 month:02 pages:541-558 https://dx.doi.org/10.1007/s40121-021-00408-8 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2021 1 14 02 541-558 |
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10.1007/s40121-021-00408-8 doi (DE-627)SPR043483712 (DE-599)SPRs40121-021-00408-8-e (SPR)s40121-021-00408-8-e DE-627 ger DE-627 rakwb eng 610 ASE Maraolo, Alberto E. verfasserin aut The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials. Active therapy (dpeaa)DE-He213 Carbapenem-resistant (dpeaa)DE-He213 Individual patient data meta-analysis (dpeaa)DE-He213 Monotherapy (dpeaa)DE-He213 Corcione, Silvia verfasserin aut Grossi, Adriano verfasserin aut Signori, Alessio verfasserin aut Alicino, Cristiano verfasserin aut Hussein, Khetam verfasserin aut Trecarichi, Enrico M. verfasserin aut Viale, Pierluigi verfasserin aut Timsit, Jean-François verfasserin aut Veeraraghavan, Balaji verfasserin aut Villegas, Maria V. verfasserin aut Rahav, Galia verfasserin aut Daikos, George L. verfasserin aut Vardakas, Konstantinos Z. verfasserin aut Roilides, Emmanuel verfasserin aut Uhlemann, Anne-Catrin verfasserin aut Ghafur, Abdul K. verfasserin aut Mornese Pinna, Simone verfasserin aut Bassetti, Matteo verfasserin aut Kohler, Philipp P. verfasserin aut Giacobbe, Daniele R. verfasserin aut Enthalten in Infectious diseases and therapy Heidelberg : Springer, 2012 10(2021), 1 vom: 14. Feb., Seite 541-558 (DE-627)735690766 (DE-600)2701611-0 2193-6382 nnns volume:10 year:2021 number:1 day:14 month:02 pages:541-558 https://dx.doi.org/10.1007/s40121-021-00408-8 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2021 1 14 02 541-558 |
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Maraolo, Alberto E. @@aut@@ Corcione, Silvia @@aut@@ Grossi, Adriano @@aut@@ Signori, Alessio @@aut@@ Alicino, Cristiano @@aut@@ Hussein, Khetam @@aut@@ Trecarichi, Enrico M. @@aut@@ Viale, Pierluigi @@aut@@ Timsit, Jean-François @@aut@@ Veeraraghavan, Balaji @@aut@@ Villegas, Maria V. @@aut@@ Rahav, Galia @@aut@@ Daikos, George L. @@aut@@ Vardakas, Konstantinos Z. @@aut@@ Roilides, Emmanuel @@aut@@ Uhlemann, Anne-Catrin @@aut@@ Ghafur, Abdul K. @@aut@@ Mornese Pinna, Simone @@aut@@ Bassetti, Matteo @@aut@@ Kohler, Philipp P. @@aut@@ Giacobbe, Daniele R. @@aut@@ |
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Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. 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Maraolo, Alberto E. |
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Maraolo, Alberto E. ddc 610 misc Active therapy misc Carbapenem-resistant misc Individual patient data meta-analysis misc Monotherapy The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients |
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610 ASE The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients Active therapy (dpeaa)DE-He213 Carbapenem-resistant (dpeaa)DE-He213 Individual patient data meta-analysis (dpeaa)DE-He213 Monotherapy (dpeaa)DE-He213 |
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The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients |
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The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients |
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Maraolo, Alberto E. Corcione, Silvia Grossi, Adriano Signori, Alessio Alicino, Cristiano Hussein, Khetam Trecarichi, Enrico M. Viale, Pierluigi Timsit, Jean-François Veeraraghavan, Balaji Villegas, Maria V. Rahav, Galia Daikos, George L. Vardakas, Konstantinos Z. Roilides, Emmanuel Uhlemann, Anne-Catrin Ghafur, Abdul K. Mornese Pinna, Simone Bassetti, Matteo Kohler, Philipp P. Giacobbe, Daniele R. |
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impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients |
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The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients |
| abstract |
Introduction Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials. |
| abstractGer |
Introduction Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials. |
| abstract_unstemmed |
Introduction Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials. |
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The Impact of Carbapenem Resistance on Mortality in Patients With Klebsiella Pneumoniae Bloodstream Infection: An Individual Patient Data Meta-Analysis of 1952 Patients |
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Corcione, Silvia Grossi, Adriano Signori, Alessio Alicino, Cristiano Hussein, Khetam Trecarichi, Enrico M. Viale, Pierluigi Timsit, Jean-François Veeraraghavan, Balaji Villegas, Maria V. Rahav, Galia Daikos, George L. Vardakas, Konstantinos Z. Roilides, Emmanuel Uhlemann, Anne-Catrin Ghafur, Abdul K. Mornese Pinna, Simone Bassetti, Matteo Kohler, Philipp P. Giacobbe, Daniele R. |
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Methods We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. 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