Experiencia clínica con infecciones causadas por Klebsiella pneumoniae productora de carbapenemasa, en una institución de enseñanza universitaria en Medellín, Colombia

Abstract

Background Carbapenemase-producing Klebsiella pneumoniae (KPC) infections are a worldwide public health problem. Since 2008, our institution has experienced endemic cases of KPC infection after an outbreak whose index case was a patient from Israel admitted for liver transplantation. Objective To describe the clinical characteristics and mortality of inpatients with nosocomial KPC infections. Methods Retrospective, descriptive observational study. Results A total of 52 patients were included, with an average age of 45.7 ± 27 years; 65.4% were men. Use of immunosuppressants, gastrointestinal surgery, chronic liver disease and solid organ transplantation were significant comorbidities. All the patients had received antibiotics before the KPC infection. The primary infections were bacteraemia (30.7%), intra-abdominal infections (23.1%) and pneumonia (17.3%). Treatment was directed by antibiogram in 50.7% of cases. Tigecycline was administered in 51.9% of cases and colistin in 32.7%, both in combination therapy with other antibiotics. Colistin plus tigecycline was used in 15.4% of cases. The treatment duration was 15.7 ± 7.5 days, with 51.9% of patients developing bacteraemia and acute renal failure and 76.9% requiring ICU care. Mortality was 48.1% and was significantly higher in the patients with bacteraemia compared with those without (74.1 vs. 20%, respectively, p ≤ 0.01). There were no significant differences in mortality between tigecycline and colistin use (45 vs. 52%, respectively, p = 0.609). Conclusion Immunosuppression, gastrointestinal surgery, previous treatment with antibiotics and ICU stay are important factors for infection with KPC. Mortality is high despite targeted therapy, particularly in patients with bacteraemia.