Carbapenem-resistant Klebsiella UTIs tied to poor outcomes

Takeaway

• Urinary tract infections (UTIs) caused by KPC carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) are associated with higher clinical failure, potentially due to inappropriate empirical treatment.

Why this matters

• Prescribe early, targeted treatment in KPC-Kp UTI whenever possible.
• In outbreak situations, consider newer agents for empirical treatment, e.g., ceftazidime-avibactam, meropenem-vaborbactam.

Key results

• Of 142 Kp UTIs, 32.4% (46) were due to KPC-Kp, 67.6% (96) due to non-KPC-Kp.
• Median Charlson Comorbidity index, 4 (interquartile range, 2-6); 45.8% (65) cases received antibiotics in previous months, 73.2% (104) complicated UTI (mostly indwelling catheter-related), 62% (88) nosocomial or health-care-associated.
• Adjusted analysis: number of hospitalisation days in previous 6 months (OR, 1.04; P=.004), antibiotic therapy in previous 6 months (OR, 4.51; P=.003), indwelling catheter in previous week (OR, 2.88; P=.04).
• 73.9% vs 38.5%, KPC-Kp UTI, non-KPC-Kp UTI patients, respectively, received inappropriate empirical treatment.
• Clinical failure at day 21 (adjusted) associated with KPC-Kp etiology (OR, 3.8; P=.001), Pitt bacteraemia score (OR, 1.51; P=.003), inappropriate empirical treatment (OR, 2.61; P=.02).

Study design

• Retrospective, observational cohort investigation of prognostic effect of KPC-Kp in K pneumoniae-associated UTI outcomes among hospitalised patients.
• Funding: Spanish Network for Research in Infectious Diseases.

Limitations

• Retrospective, observational.
• Sample size.
• Pitt bacteraemia score unvalidated for sample.