Observational studyCritical care (London, England)2020
Time to appropriate antibiotic therapy is a predictor of outcome in patients with bloodstream infection caused by KPC-producing Klebsiella pneumoniae.
Observational study in Critical care (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 139 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
139 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Effect of antibiotic regimens for bloodstream infections caused by KPC-producing enterobacter: a network meta-analysis.Frontiers in medicine · 2026Pooled it
- Female Sex and Mortality in Patients With Gram-Negative Bacteremia: A Systematic Review and Meta-Analysis.JAMA network open · 2025Pooled it
- Pooled it
- Pooled it
- Efficacy and Safety of Ceftazidime-Avibactam for the Treatment of Carbapenem-ResistantMicrobiology spectrum · 2022Pooled it
- Effects of Inappropriate Administration of Empirical Antibiotics on Mortality in Adults With Bacteraemia: Systematic Review and Meta-Analysis.Frontiers in medicine · 2022Pooled it
- Interplay between Nox2 Activity and Platelet Activation in Patients with Sepsis and Septic Shock: A Prospective Study.Oxidative medicine and cellular longevity · 2020Trial
- Real-world effectiveness and treatment costs of ceftazidime-avibactam versus colistin-meropenem for ICU-acquired MDR gram-negative infections in liver transplant recipients.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Resistance phenotype, infection source, and empirical therapy in ICU-onset gram-negative bloodstream infections: Associations with 30-day mortality.Irish journal of medical science · 2026Article
- Bacteremia evaluation with T2 magnetic resonance in the emergency room (BETTER).Microbiology spectrum · 2026Observational
- When might we consider using the newer β-lactam agents as empirical therapy against presumed carbapenem-resistant gram-negative infections?JAC-antimicrobial resistance · 2026Review
- Clinical outcomes and therapeutic approaches in pediatric infections caused by metallo-β-lactamase-producing organisms: a five-year experience in a tertiary care hospital.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Ceftazidime-avibactam for multidrug-resistant gram-negative infections: outcomes and timing of initiation across 22 U.S. medical centers.Antimicrobial agents and chemotherapy · 2026Article
- Clinical outcomes and plasmid-associated features in KPC-producing Klebsiella pneumoniae bacteraemia.Tropical medicine and health · 2026Article
- Challenges and opportunities in the management of severe pneumonia. Key concepts from the Seventh Annual Meeting of Spanish Experts 2025.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- Clinical outcomes and mortality in carbapenem-resistant versus susceptible Klebsiella pneumoniae bloodstream infections in intensive care units.BMC infectious diseases · 2026Article
- Association of Once-Daily MALDI-TOF MS Identification with Antibiotic Appropriateness and First-Modification Patterns in Emergency Department Bacteremia: A Retrospective Before-After Cohort Study.Antibiotics (Basel, Switzerland) · 2026Article
- Comparison of outcomes of KPC-producing Enterobacterales bloodstream infections treated with ceftazidime-avibactam and other conventional antibiotics: retrospective single-center study.Microbiology spectrum · 2026Observational
- Clinical Characteristics and Outcomes of Bloodstream Infections Caused by Metallo-β-Lactamase-Producing Enterobacterales in Argentina: A Subanalysis of the EMBARCAR Prospective Multicenter Cohort Study.Open forum infectious diseases · 2026Article
- Prognostic factors for mortality in critically ill patients with infections caused by carbapenem-resistant gram-negative pathogens treated with ceftazidime-avibactam: a multicenter retrospective study.BMC infectious diseases · 2026Article
79 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
backgroundBloodstream infections (BSIs) by Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (Kp) are associated with high mortality. The aim of this study is to assess the relationship between time to administration of appropriate antibiotic therapy and the outcome of patients with BSI due to KPC-Kp hospitalized in intensive care unit (ICU).
methodsAn observational study was conducted in the ICUs of two academic centers in Italy. Patients with KPC-Kp bacteremia hospitalized between January 2015 to December 2018 were included. The primary outcome was the relationship between time from blood cultures (BC) collection to appropriate antibiotic therapy and 30-day mortality. The secondary outcome was to evaluate the association of different treatment regimens with 30-day mortality and a composite endpoint (30-day mortality or nephrotoxicity). A Cox regression analysis to identify factors independently associated with 30-day mortality was performed. Hazard ratio (HR) and 95% confidence interval (CI) were calculated.
resultsA total of 102 patients with KPC-Kp BSI were included. The most common sources of infection were intra-abdominal (23.5%), urinary tract (20.6%), and skin and skin structure (17.6%). The 30-day mortality was 45%. Median time to appropriate antibiotic therapy was shorter in patients who survived (8.5 h [IQR 1-36]) versus those who died (48 h [IQR 5-108], p = 0.014). A propensity score matching showed that receipt of an in vitro active therapy within 24 h from BC collection was associated with lower 30-day mortality (HR = 0.36, 95% CI: 0.188-0.690, p = 0.0021). At Cox regression analysis, factors associated with 30-day mortality were primary bacteremia (HR 2.662 [95% CI 1.118-6.336], p = 0.027), cardiovascular disease (HR 2.196 [95% CI 1.082-4.457], p = 0.029), time (24-h increments) from BC collection to appropriate therapy (HR 1.382 [95% CI 1.132-1.687], p = 0.001), SOFA score (HR 1.122 [95% CI 1.036-1.216], p = 0.005), and age (HR 1.030 [95% CI 1.006-1.054], p = 0.012). Ceftazidime-avibactam-containing regimens were associated with reduced risk of composite endpoint (30-day mortality OR nephrotoxicity) (HR 0.231 [95% CI 0.071-0.745], p = 0.014) compared to colistin-containing regimens.
conclusionsTime to appropriate antibiotic therapy is an independent predictor of 30-day mortality in patients with KPC-Kp BSI. Appropriate antibiotic therapy should begin within 24 h from the collection of BC.
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