BMC infectious diseases · 2026
Early procalcitonin kinetics as an independent predictor of mortality in multi-drug resistant Klebsiella spp. bloodstream infections: a retrospective cohort study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Korkmaz Nesibe, Şentürk Gönül Çiçek, Yılmaz Feray Aycan, Kul Gülnur, Güldoğan Bedirhan, Yılmaz Hatice Merve, Şahin Fatma Zehra, Ertekin Hicret, Solay Aslı Haykır, Kuzi Semanur, Bulut Dilek, Tütüncü Emin Ediz
Аннотация
BACKGROUND: Klebsiella spp. causing bloodstream infections (BSIs) with resistance to carbapenems and/or colistin are associated with high mortality and limited treatment options. While procalcitonin (PCT) kinetics have prognostic value in other settings, their role in resistant Klebsiella spp. infections remains unclear. This study aimed to evaluate the predictors of 14 day mortality and the prognostic value of early PCT kinetics in this high risk population.
METHODS: We conducted a retrospective study at a tertiary care center, including adult intensive care unit (ICU) patients with monomicrobial BSIs due to carbapenem and/or colistin-resistant Klebsiella spp. demographic and clinical data, severity scores, antimicrobial regimens, and PCT values at baseline and 72 h were recorded. Analyses were performed separately for the carbapenem-resistant and colistin-resistant cohorts. An early PCT response was defined as a ≥50% decline at 72 h. Logistic regression analysis was used to identify factors associated with 14 day mortality.
RESULTS: A total of 211 carbapenem-resistant Klebsiella spp. BSIs episodes and 104 colistin-resistant episodes were analyzed as two partially overlapping cohorts. Among the carbapenem-resistant isolates, 97 were also resistant to colistin, while seven colistin-resistant isolates were carbapenem susceptible. The overall 14 day mortality rate was 49.3%. In the carbapenem-resistant group, malignancy, Pitt bacteremia score ≥4, and lactate ≥2 mmol/L were independently associated with mortality. In contrast, appropriate pathogen directed therapy and early PCT response were protective factors in both cohorts. In the colistin-resistant group, definitive therapy with ceftazidime-avibactam was associated with the lowest mortality, while regimens including tigecycline or fosfomycin were associated with better outcomes than fully inactive therapy.
CONCLUSIONS: Mortality in carbapenem and colistin-resistant Klebsiella BSIs remains high and is primarily driven by illness severity. Early PCT decline and appropriate definitive therapy were independently associated with improved survival. Monitoring PCT kinetics may provide timely prognostic guidance and support early treatment optimization, particularly in settings with limited access to newer antimicrobial agents.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: We conducted a retrospective study at a tertiary care center, including adult intensive care unit (ICU) patients with monomicrobial BSIs due to carbapenem and/or colistin-resistant Klebsiella spp. demographic and clinical data, severity scores, antimicrobial regimens, and PCT values at baseline and 72 h were recorded. Analyses were performed separately for the carbapenem-resistant and colistin-resistant cohorts. An early PCT response was defined as a ≥50% decline at 72 h. Logistic regression analysis was used to identify factors associated with 14 day mortality.
RESULTS: A total of 211 carbapenem-resistant Klebsiella spp. BSIs episodes and 104 colistin-resistant episodes were analyzed as two partially overlapping cohorts. Among the carbapenem-resistant isolates, 97 were also resistant to colistin, while seven colistin-resistant isolates were carbapenem susceptible. The overall 14 day mortality rate was 49.3%. In the carbapenem-resistant group, malignancy, Pitt bacteremia score ≥4, and lactate ≥2 mmol/L were independently associated with mortality. In contrast, appropriate pathogen directed therapy and early PCT response were protective factors in both cohorts. In the colistin-resistant group, definitive therapy with ceftazidime-avibactam was associated with the lowest mortality, while regimens including tigecycline or fosfomycin were associated with better outcomes than fully inactive therapy.
CONCLUSIONS: Mortality in carbapenem and colistin-resistant Klebsiella BSIs remains high and is primarily driven by illness severity. Early PCT decline and appropriate definitive therapy were independently associated with improved survival. Monitoring PCT kinetics may provide timely prognostic guidance and support early treatment optimization, particularly in settings with limited access to newer antimicrobial agents.
CLINICAL TRIAL NUMBER: Not applicable.
Предметные рубрики MeSH
Retrospective StudiesBacteremiaCarbapenem-Resistant EnterobacteriaceaeKlebsiellaDrug Resistance, Multiple, BacterialProcalcitoninPrognosisKlebsiella InfectionsCarbapenemsColistinAnti-Bacterial AgentsCeftazidimeAzabicyclo CompoundsTigecyclineFosfomycinHumansMaleFemaleMiddle AgedAgedAged, 80 and overDrug Combinations