835 - Comparison of the outcomes of patients with KPC and NDM-1-producing Enterobacteriaceae

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Presenting Author(s)

HS

Hyeonji Seo

Fellow
Asan Medical Center
Songpa-gu, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

MK

Min Jae Kim

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
YC

Yong Pil Chong

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SK

Sung-Han Kim

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SL

Sang-Oh Lee

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SC

Sang-Ho Choi

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
YK

Yang Soo Kim

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JW

Jun Hee Woo

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JJ

Jiwon Jung

Assistant Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Carbapenemase-producing Enterobacteriaceae infections are associated with high mortality. We aimed to compare the clinical outcomes of patients with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae and those with New-Delhi-Metallo-beta-lactamase-1 (NDM-1)-producing Enterobacteriaceae.

Methods: We performed a retrospective cohort study of all adult patients ( > 16 years old) with KPC or NDM-1-producing Enterobacteriaceae isolates in a 2,700-bed tertiary referral hospital in Seoul, South Korea between 2010 and 2019. Primary outcomes were infection within 30 days and 30-day mortality after the first isolation of KPC or NDM-1-producing Enterobacteriaceae.

Results: A total of 859 patients were identified during the study period. Of them, 475 (55%) were KPC group and 384 (45%) were NDM-1 group. KPC group tended to develop infection within 30 days after first isolation more frequently than NDM-1 group (31% vs. 26%; P = 0.07). Thirty-day mortality was significantly higher in KPC group compared to NDM-1 group (KPC, 17% (81/475) versus NDM-1, 9% (33/384), P < 0.001). Multivariate analysis revealed that APACHE II score (adjusted odds ratio [aOR], 1.12; P < 0.001), solid cancer (aOR, 2.56; P < 0.001), previous carbapenem therapy (aOR, 1.93; P = 0.004), development of infection of KPC or NDM-1-producing Enterobacteriaceae within 30 days (aOR, 2.63; P < 0.001), and KPC-producing Enterobacteriaceae (aOR, 1.62; P = 0.045) were independent risk factors for 30-day mortality.Table 1. Results of analyses of risk factors for 30-day mortality from initial positive culture date in patients with KPC or NDM-1- producing Enterobacteriaceae

Figure 1. Kaplan–Meier survival estimates of patients with KPC or NDM-1-producing Enterobacteriaceae for 30-day mortality after first isolation: KPC (continuous line) versus NDM (dotted line). (log-rank test).

Conclusion: Our study suggests that KPC-producing Enterobacteriaceae is associated with poorer outcome compared to NDM-1-producing Enterobacteriaceae. Therefore, patients with KPC-producing Enterobacteriaceae colonization should be monitored carefully for development of infection, and appropriate antibiotics should be initiated as soon as possible.