P414 Predictors of mortality in KPC-Kp bloodstream infection in intensive care units in Italy

Introduction Over the last decade, the prevalence of strains of Klebsiella Pneumoniae Carbapenemases (KPC) producing K. pneumoniae (Kp) has dramatically increased worldwide and has become a significant problem in terms of public health, especially in some countries. Methods In this retrospective observational study conducted in Intensive Care Units (ICU) of the the Italian teaching Hospital of Pisa, we recruited critically ill patients with a diagnosis of bloodstream infections (BSI) caused by KPC-Kp. 30-days mortality from the first positive blood culture, septic shock diagnosis, steroid therapy, SOFA, SAPS II, Charlson Score, antibiotics therapy, previous hospitalization were compared between Survivor and Non-Survivor groups. Results We enrolled 42 patients admitted in ICU between January 2012 and December 2015. The overall 30 days mortality rate was 52,4%. A significantly higher rate was observed among patients with a diagnosis of septic shock at BSI onset, steroid therapy, higher SOFA and SAPS II score. Gentamicin used in combination therapy was associated with lower mortality, regardless of meropenem use. Furthermore, in colonized patients the digestive decontamination with oral Gentamicin decreased BSI mortality. Previous use of meropenem was associated with increased mortality. Additionally, the intravenous admistration of Fosfomicin resulted in a lower mortality rate. Charlson score and optimal empirical therapy seemed not to have a significant influence on survival. Conclusions KPC-Kp BSI was associated with high mortality. We found that a regime therapy including gentamicin is associeted with lower mortality. Futher prospective studies should be done to confirm our result.