{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:00:30Z","timestamp":1791561630274,"version":"4.3.4"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Infections caused by Klebsiella pneumoniae (Kp) carbapenemase (KPC)-producing strains of Kp have become a significant threat in recent years. To assess their outcomes and identify risk factors for 14 day mortality, we conducted a 4 year (2010\u201313) retrospective cohort study in five large Italian teaching hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The cohort included 661 adults with bloodstream infections (BSIs; n\u200a=\u200a447) or non-bacteraemic infections (lower respiratory tract, intra-abdominal structure, urinary tract or other sites) caused by a KPC-Kp isolate. All had received \u226548 h of therapy (empirical and\/or non-empirical) with at least one drug to which the isolate was susceptible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most deaths occurred within 2 weeks of infection onset (14 day mortality: 225\/661, 34.1%). Logistic regression analysis identified BSI (OR, 2.09; 95% CI, 1.34\u20133.29), presentation with septic shock (OR, 2.45; 95% CI, 1.47\u20134.08), inadequate empirical antimicrobial therapy (OR, 1.48; 95% CI, 1.01\u20132.18), chronic renal failure (OR, 2.27; 95% CI, 1.44\u20133.58), high APACHE III score (OR, 1.05; 95% CI, 1.04\u20131.07) and colistin-resistant isolates (OR, 2.18; 95% CI, 1.37\u20133.46) as independent predictors of 14 day mortality. Combination therapy with at least two drugs displaying in vitro activity against the isolate was associated with lower mortality (OR, 0.52; 95% CI, 0.35\u20130.77), in particular in patients with BSIs, lung infections or high APACHE III scores and\/or septic shock at infection onset. Combinations that included meropenem were associated with significantly higher survival rates when the KPC-Kp isolate had a meropenem MIC of \u22648 mg\/L.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>KPC-Kp infections are associated with high mortality. Treatment with two or more drugs displaying activity against the isolate improves survival, mainly in patients who are critically ill.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkv086","type":"journal-article","created":{"date-parts":[[2017,2,1]],"date-time":"2017-02-01T13:25:28Z","timestamp":1485955528000},"page":"2133-2143","source":"Crossref","is-referenced-by-count":427,"title":["Infections caused by KPC-producing\n                    <i>Klebsiella pneumoniae<\/i>\n                    : differences in therapy and mortality in a multicentre study"],"prefix":"10.1093","volume":"70","author":[{"given":"Mario","family":"Tumbarello","sequence":"first","affiliation":[{"name":"1 \u00a0Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico Maria","family":"Trecarichi","sequence":"additional","affiliation":[{"name":"1 \u00a0Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Giuseppe","family":"De Rosa","sequence":"additional","affiliation":[{"name":"2 \u00a0Department of Medical Sciences, University of Turin, Torino, Italy"},{"name":"3 \u00a0Infectious Diseases at Amedeo di Savoia Hospital, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maddalena","family":"Giannella","sequence":"additional","affiliation":[{"name":"4 \u00a0Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele Roberto","family":"Giacobbe","sequence":"additional","affiliation":[{"name":"5 \u00a0Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Bassetti","sequence":"additional","affiliation":[{"name":"6 \u00a0Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Raffaella","family":"Losito","sequence":"additional","affiliation":[{"name":"1 \u00a0Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Bartoletti","sequence":"additional","affiliation":[{"name":"4 \u00a0Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Del Bono","sequence":"additional","affiliation":[{"name":"5 \u00a0Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Corcione","sequence":"additional","affiliation":[{"name":"2 \u00a0Department of Medical Sciences, University of Turin, Torino, Italy"},{"name":"3 \u00a0Infectious Diseases at Amedeo di Savoia Hospital, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Maiuro","sequence":"additional","affiliation":[{"name":"1 \u00a0Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Tedeschi","sequence":"additional","affiliation":[{"name":"4 \u00a0Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Celani","sequence":"additional","affiliation":[{"name":"1 \u00a0Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara Simona","family":"Cardellino","sequence":"additional","affiliation":[{"name":"2 \u00a0Department of Medical Sciences, University of Turin, Torino, Italy"},{"name":"3 \u00a0Infectious Diseases at Amedeo di Savoia Hospital, Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Spanu","sequence":"additional","affiliation":[{"name":"7 \u00a0Institute of Microbiology, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Marchese","sequence":"additional","affiliation":[{"name":"8 \u00a0Microbiology Unit, University of Genoa (DISC) and IRCCS San Martino-IST, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Ambretti","sequence":"additional","affiliation":[{"name":"9 \u00a0Operative Unit of Clinical Microbiology, S. Orsola-Malpighi Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Cauda","sequence":"additional","affiliation":[{"name":"1 \u00a0Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Viscoli","sequence":"additional","affiliation":[{"name":"5 \u00a0Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Viale","sequence":"additional","affiliation":[{"name":"4 \u00a0Clinic of Infectious Diseases, University of Bologna, S. 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