Rivera-Espinar, FranciscoMachuca, IsabelTejero, RocioRodriguez, JorgeMula, AnaMarfil, EduardoCano, AngelaGutierrez-Gutierrez, BelenRodriguez, MarinaPozo, Juan CarlosDe la Fuente, CarmenRodriguez-Baño, JesusMartinez-Martinez, LuisLeon, RafaelTorre-Cisneros, Julian2023-02-082023-02-082020-03-08Rivera-Espinar F, Machuca I, Tejero R, Rodríguez J, Mula A, Marfil E, et al. Impact of KPC Production and High-Level Meropenem Resistance on All-Cause Mortality of Ventilator-Associated Pneumonia in Association with Klebsiella pneumoniae. Antimicrob Agents Chemother. 2020 May 21;64(6):e02164-19http://hdl.handle.net/10668/15276Carbapenemase-producing Enterobacterales and specifically Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) are rapidly spreading worldwide. The prognosis of ventilator-associated pneumonia (VAP) caused by KPC-Kp is not well known. Our study tries to assess whether ventilator-associated pneumonia caused by a KPC-Kp strain is associated with higher all-cause mortality than that caused by carbapenem-susceptible isolates. This is a retrospective cohort study of patients with VAP due to K. pneumoniae from a 35-bed polyvalent intensive care unit in a university hospital (>40,000 annual admissions) between January 2012 and December 2016. Adjusted multivariate analysis was used to study the association of KPC-Kp with 30-day all-cause mortality (Cox regression). We analyze 69 cases of K. pneumoniae VAP, of which 39 were produced by a KPC-Kp strain with high-level resistance to meropenem (MIC > 16 mg/ml). All-cause mortality at 30 days was 41% in the KPC-Kp group (16/39) and 33.3% in the carbapenem-susceptible cases (10/30). KPC-Kp etiology was not associated with higher mortality when controlled for confounders (adjusted hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.46 to 3.41). Adequate targeted therapy (HR, 0.03; 95% CI, 40,000 annual admissions) between January 2012 and December 2016. Adjusted multivariate analysis was used to study the association of KPC-Kp with 30-day all-cause mortality (Cox regression). We analyze 69 cases of K. pneumoniae VAP, of which 39 were produced by a KPC-Kp strain with high-level resistance to meropenem (MIC > 16 mg/ml). All-cause mortality at 30 days was 41% in the KPC-Kp group (16/39) and 33.3% in the carbapenem-susceptible cases (10/30). KPC-Kp etiology was not associated with higher mortality when controlled for confounders (adjusted hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.46 to 3.41). Adequate targeted therapy (HR, 0.03; 95% CI,  16 mg/ml). All-cause mortality at 30 days was 41% in the KPC-Kp group (16/39) and 33.3% in the carbapenem-susceptible cases (10/30). KPC-Kp etiology was not associated with higher mortality when controlled for confounders (adjusted hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.46 to 3.41). Adequate targeted therapy (HR, 0.03; 95% CI,0.01 to0.23) was associated with all-cause mortality. Assuming the limitations due to theavailable sample size, the prognosis of VAP caused by KPC-Kp is similar to VAPscaused by carbapenem-susceptible K. pneumoniae when appropriate treatment isused.enKPCKlebsiella pneumoniaeMortalityVentilator-associated pneumoniaAnti-bacterial agentsBacterial proteinsHumansKlebsiella infectionsKlebsiella pneumoniaeMeropenemPneumonia, ventilator-associatedRetrospective studiesbeta-lactamasesresearch article32205347open accessAntibacterianosEstudios retrospectivosInfecciones por KlebsiellaKlebsiella pneumoniaeMeropenemNeumonía asociada al ventiladorProteínas bacterianas10.1128/AAC.02164-191098-6596PMC7269473https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269473https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269473/pdf