Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-Producing <i>Klebsiella pneumoniae</i> for Febrile Neutropenic Episodes in Colonized Children with Acute Leukemia—An 8-Year Retrospective Observational Study
In children with acute leukemia (AL), the mortality rate from <i>Klebsiella pneumoniae</i> carbapenemase (KPC)-producing <i>K. pneumoniae</i> bloodstream infection (KPC-KpBSI) exceeds 50%, highest when active treatment is delayed. Neutropenic KPC-<i>K. pneumoniae</i&...
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2024-10-01
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| author | Alessandra Micozzi Cristina Luise Chiara Lisi Luisa Moleti Stefania Santilli Giuseppe Gentile |
| author_facet | Alessandra Micozzi Cristina Luise Chiara Lisi Luisa Moleti Stefania Santilli Giuseppe Gentile |
| author_sort | Alessandra Micozzi |
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| description | In children with acute leukemia (AL), the mortality rate from <i>Klebsiella pneumoniae</i> carbapenemase (KPC)-producing <i>K. pneumoniae</i> bloodstream infection (KPC-KpBSI) exceeds 50%, highest when active treatment is delayed. Neutropenic KPC-<i>K. pneumoniae</i> carriers are at high risk of KPC-KpBSI, and preemptive empiric antibiotic treatment (EAT) of febrile neutropenic episodes (FNEs) active against KPC-<i>K. pneumoniae</i> may reduce this mortality. We conducted an 8-year (2014–2021) retrospective observational study of 112 febrile neutropenic episodes (FNEs) in 32 children with AL who were KPC-<i>K. pneumoniae</i> carriers: standard EAT for 39 FNEs and active EAT for 73 FNEs (52 ceftazidime/avibactam (CAZAVI)-based and 21 colistin-based combinations, and 5 CAZAVI monotherapy). Successful outcomes (survival from FNE) were observed in 94%; seven were fatal, with four due to infectious causes. KPC-KpBSIs caused 10/112 FNEs, 10/20 g-negative BSIs, and 3 deaths. The mortality rate of KPC-KpBSI was 30%. Active EAT was successful in 97% of the FNEs, compared to 87% with standard EAT. All deaths from KPC-KpBSI occurred in patients who received standard EAT, while none occurred with active EAT. KPC-KpBSI mortality rate with initial inactive treatment was 60%. CAZAVI-based EAT was successful in all FNEs, with a higher success rate without any modification compared to colistin-based EAT, where nephrotoxicity occurred in 14%. Therefore, active EAT, mainly a CAZAVI-based combination, was effective, safe, and associated with low overall and KPC-KpBSI-related mortality. |
| format | Article |
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| institution | Kabale University |
| issn | 2079-6382 |
| language | English |
| publishDate | 2024-10-01 |
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| series | Antibiotics |
| spelling | doaj-art-a31a05f623a542dcab973765c3990d712024-11-26T17:46:22ZengMDPI AGAntibiotics2079-63822024-10-011311101710.3390/antibiotics13111017Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-Producing <i>Klebsiella pneumoniae</i> for Febrile Neutropenic Episodes in Colonized Children with Acute Leukemia—An 8-Year Retrospective Observational StudyAlessandra Micozzi0Cristina Luise1Chiara Lisi2Luisa Moleti3Stefania Santilli4Giuseppe Gentile5Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, ItalyHaematology, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, 80131 Naples, ItalyHaematology, Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, 00161 Rome, ItalyDepartment of Diagnostics, Azienda Policlinico Umberto I, 00161 Rome, ItalyHaematology, Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, ItalyIn children with acute leukemia (AL), the mortality rate from <i>Klebsiella pneumoniae</i> carbapenemase (KPC)-producing <i>K. pneumoniae</i> bloodstream infection (KPC-KpBSI) exceeds 50%, highest when active treatment is delayed. Neutropenic KPC-<i>K. pneumoniae</i> carriers are at high risk of KPC-KpBSI, and preemptive empiric antibiotic treatment (EAT) of febrile neutropenic episodes (FNEs) active against KPC-<i>K. pneumoniae</i> may reduce this mortality. We conducted an 8-year (2014–2021) retrospective observational study of 112 febrile neutropenic episodes (FNEs) in 32 children with AL who were KPC-<i>K. pneumoniae</i> carriers: standard EAT for 39 FNEs and active EAT for 73 FNEs (52 ceftazidime/avibactam (CAZAVI)-based and 21 colistin-based combinations, and 5 CAZAVI monotherapy). Successful outcomes (survival from FNE) were observed in 94%; seven were fatal, with four due to infectious causes. KPC-KpBSIs caused 10/112 FNEs, 10/20 g-negative BSIs, and 3 deaths. The mortality rate of KPC-KpBSI was 30%. Active EAT was successful in 97% of the FNEs, compared to 87% with standard EAT. All deaths from KPC-KpBSI occurred in patients who received standard EAT, while none occurred with active EAT. KPC-KpBSI mortality rate with initial inactive treatment was 60%. CAZAVI-based EAT was successful in all FNEs, with a higher success rate without any modification compared to colistin-based EAT, where nephrotoxicity occurred in 14%. Therefore, active EAT, mainly a CAZAVI-based combination, was effective, safe, and associated with low overall and KPC-KpBSI-related mortality.https://www.mdpi.com/2079-6382/13/11/1017childrenacute leukemiafebrile neutropeniaKPC-<i>Klebsiella pneumoniae</i>empiric antibiotic treatment |
| spellingShingle | Alessandra Micozzi Cristina Luise Chiara Lisi Luisa Moleti Stefania Santilli Giuseppe Gentile Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-Producing <i>Klebsiella pneumoniae</i> for Febrile Neutropenic Episodes in Colonized Children with Acute Leukemia—An 8-Year Retrospective Observational Study Antibiotics children acute leukemia febrile neutropenia KPC-<i>Klebsiella pneumoniae</i> empiric antibiotic treatment |
| title | Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-Producing <i>Klebsiella pneumoniae</i> for Febrile Neutropenic Episodes in Colonized Children with Acute Leukemia—An 8-Year Retrospective Observational Study |
| title_full | Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-Producing <i>Klebsiella pneumoniae</i> for Febrile Neutropenic Episodes in Colonized Children with Acute Leukemia—An 8-Year Retrospective Observational Study |
| title_fullStr | Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-Producing <i>Klebsiella pneumoniae</i> for Febrile Neutropenic Episodes in Colonized Children with Acute Leukemia—An 8-Year Retrospective Observational Study |
| title_full_unstemmed | Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-Producing <i>Klebsiella pneumoniae</i> for Febrile Neutropenic Episodes in Colonized Children with Acute Leukemia—An 8-Year Retrospective Observational Study |
| title_short | Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-Producing <i>Klebsiella pneumoniae</i> for Febrile Neutropenic Episodes in Colonized Children with Acute Leukemia—An 8-Year Retrospective Observational Study |
| title_sort | benefits and safety of empiric antibiotic treatment active against kpc producing i klebsiella pneumoniae i for febrile neutropenic episodes in colonized children with acute leukemia an 8 year retrospective observational study |
| topic | children acute leukemia febrile neutropenia KPC-<i>Klebsiella pneumoniae</i> empiric antibiotic treatment |
| url | https://www.mdpi.com/2079-6382/13/11/1017 |
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