Comparison of septic shock due to MDR Acinetobacter baumannii or Klebsiella pneumoniae carbapenemase--producing K. pneumoniae in ICU patients [PublishAheadOfPrint]

Objectives: a significant cause of mortality in intensive care unit (ICU) is represented by multidrug-resistant (MDR) gram-negative bacteria, such as MDR Acinetobacter baumannii (MDR-AB) and Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp). Aim of the present study was the comparison of clinical features, therapy and outcome of patients who developed septic shock due to either MDR-AB or KPC-Kp.

Methods: were retrospectively analyzed patients admitted to the intensive care unit (ICU) of a teaching hospital, from November 2010 to December 2015, who developed septic shock due to MDR-AB or KPC-Kp infection.

Results: data from 220 patients were analyzed: 128 (58.2%) were diagnosed with septic shock due to KPC-Kp and 92 (41.8%) were diagnosed with septic shock due to MDR-AB, respectively. The 30-day mortality rate was significantly higher for the MDR-AB group (84.8% Vs 44.5%, p<0.001). Steroid exposure and pneumonia were associated with MDR-AB infection, whereas hospitalization in the previous 90 days, primary bacteremia, and KPC-Kp colonization were associated with KPC-Kp infection. For patients with KPC-Kp infections, the use of ≥ 2 antibiotics active in vitro as empiric or definitive therapy was associated with higher 30-day survival, while isolation of colistin-resistant strains was linked to mortality. For patients with MDR-AB infections, age >60 years and SAPS II >45 points were associated with increased mortality rates.

Conclusions: septic shock due to MDR-AB infection is associated with very high mortality rates, compared to septic shock due to KPC-Kp. Analysis of clinical features of these critically-ill patients might help physicians in choosing appropriate empirical antimicrobial therapy.

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