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Antimicrobial Agents and Chemotherapy, May 2009, p. 1868-1873, Vol. 53, No. 5
0066-4804/09/$08.00+0     doi:10.1128/AAC.00782-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Prospective Observational Study of the Impact of VIM-1 Metallo-β-Lactamase on the Outcome of Patients with Klebsiella pneumoniae Bloodstream Infections{triangledown}

George L. Daikos,1* Panayiotis Petrikkos,1 Mina Psichogiou,1 Chris Kosmidis,1 Evangelos Vryonis,2 Athanasios Skoutelis,2 Kleoniki Georgousi,3 Leonidas S. Tzouvelekis,4 Panayotis T. Tassios,4 Christina Bamia,5 and George Petrikkos1

First Department of Propaedeutic Medicine,1 Second Department of Medicine,3 Department of Microbiology,4 Department of Hygiene and Epidemiology, University of Athens,5 Fifth Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece2

Received 14 June 2008/ Returned for modification 19 November 2008/ Accepted 4 February 2009

VIM-1-producing Klebsiella pneumoniae (VPKP) is an emerging pathogen. A prospective observational study was conducted to evaluate the importance of VIM production on outcome of patients with K. pneumoniae bloodstream infections (BSIs). Consecutive patients with K. pneumoniae BSIs were identified and followed up until patient discharge or death. A total of 162 patients were included in the analysis; 67 (41.4%) were infected with VPKP, and 95 were infected with non-VPKP. Fourteen of the patients infected with VPKP were carbapenem resistant (Carbr) (MIC > 4 µg/ml), whereas none of the non-VPKP exhibited carbapenem resistance. The patients infected with a Carbr organism were more likely (odds ratio, 4.08; 95% confidence interval [CI], 1.29 to 12.85; P = 0.02) to receive inappropriate empirical therapy. The all-cause 14-day mortality rates were 15.8% (15 of 95) for patients infected with VIM-negative organisms, 18.9% (10 of 53) for those infected with VIM-positive carbapenem-susceptible organisms, and 42.9% (6 of 14) for those infected with VIM-positive Carbr organisms (P = 0.044). In Cox regression analysis, age (hazard ratio [HR], 1.03; 95% CI, 1.01 to 1.06; P = 0.021), rapidly fatal underlying disease (HR, 2.84; 95% CI, 1.26 to 6.39; P = 0.012), and carbapenem resistance (HR, 2.83; 95% CI, 1.08 to 7.41; P = 0.035) were independent predictors of death. After adjustment for inappropriate empirical or definitive therapy, the effect of carbapenem resistance on outcome was reduced to a level of nonsignificance. In patients with K. pneumoniae BSIs, carbapenem resistance, advanced, age, and severity of underlying disease were independent predictors of outcome, whereas VIM production had no effect on mortality. The higher mortality associated with carbapenem resistance was probably mediated by the failure to provide effective therapy.

* Corresponding author. Mailing address: First Department of Propaedeutic Medicine, Laiko General Hospital, Mikras Asias 75, Athens 115-26, Greece. Phone: 30-2107462636. Fax: 30-2107462635. E-mail: gdaikos{at}med.uoa.gr

{triangledown} Published ahead of print on 17 February 2009.

Antimicrobial Agents and Chemotherapy, May 2009, p. 1868-1873, Vol. 53, No. 5
0066-4804/09/$08.00+0     doi:10.1128/AAC.00782-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Daikos, G. L., Vryonis, E., Psichogiou, M., Tzouvelekis, L. S., Liatis, S., Petrikkos, P., Kosmidis, C., Tassios, P. T., Bamias, G., Skoutelis, A. (2010). Risk factors for bloodstream infection with Klebsiella pneumoniae producing VIM-1 metallo-{beta}-lactamase. J Antimicrob Chemother : dkq005v1-dkq005 [Abstract] [Full Text]  


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