Clinical features and outcomes of bacteraemia due to OXA-48-like carbapenemase-producing Klebsiella pneumoniae in a tertiary hospital

Abstract

Introduction: Limited therapeutic options and high mortality make the management of OXA-48-like carbapenemase-producing Klebsiella pneumoniae (KPOXA-48) bacteraemia complicated. The aim of the study was to describe the clinical characteristics of KPOXA-48 bacteraemia between October 2013 and December 2016.

Material and methods: The variables to analyse were retrospectively collected from medical records. Carbapenemase production was confirmed by phenotypic and molecular methods.

Results: A total of 38 patients with bacteraemia were included, mainly classified as hospital-acquired (n=31). The majority of cases were secondary bacteraemia (n=26), most commonly arising from the urinary tract (n=11). All isolates presented a multidrug-resistant profile with the extended spectrum beta-lactamase CTX-M-15 and the carbapenemase OXA-48-like production. The crude mortality rate with adequate targeted antibiotic therapy was 0%, rising to 55% with inadequate treatment (p=0.0015).

Conclusions: This study highlights the importance of identifying this resistance mechanism, the patient factors, type of bacteraemia and adequacy of antibiotic therapy in the outcome of bacteraemia.

Keywords: Bacteraemia; Bacteriemia; Carbapenemasa; Carbapenemasa OXA-48; Carbapenemase; Klebsiella pneumoniae; OXA-48-like carbapenemase.