Bacteraemia due to OXA-48-carbapenemase-producing Enterobacteriaceae: a major clinical challenge

摘要: Bacteraemia due to carbapenemase-producing Enterobacteriaceae is an emerging medical problem. Management of this entity complicated by the difficulty in identifying resistance patterns and limited therapeutic options. A cohort study was performed including all episodes bloodstream infection OXA-48-producing (O48PE), occurring between July 2010 April 2012. Data on predisposing factors, clinical presentation, therapy outcome were collected from records. There 40 cases bacteraemia caused O48PE, 35 Klebsiella pneumoniae five Escherichia coli. Patients elderly with significant comorbidities (57.5% underlying malignancy). Thirty-five (87.5%) nosocomial, (12.5%) healthcare-associated. had frequently been exposed antibiotics invasive procedures during hospitalization. The most common source urinary tract followed deep intra-abdominal surgical site infection. Clinical presentation severe sepsis or shock 18 (45%). Extended-spectrum β-lactamase production detected 92.5% isolates. MIC(90) for ertapenem, imipenem meropenem 32, 16 mg/L, respectively. Most preserved amikacin, colistin, tigecycline fosfomycin. These combined are basis targeted therapies, carbapenem selected cases. Median delay starting clinically adequate microbiologically appropriate treatment 3 days. Crude mortality admission within 30 days 65% 50%, Bloodstream infections O48PE have a poor prognosis. Delay diagnosis initiation optimal antimicrobial frequent. Suspicion rapid identification could contribute improving outcomes.