International Journal of Antimicrobial Agents 47 (2016) 335–339 Contents lists available at ScienceDirect International Journal of Antimicrobial Agents j o ur nal ho me pag e: http://www.elsevier.com/locate/ijantimicag Short Communication Carbapenemase-producing Klebsiella pneumoniae bloodstream infections in neutropenic patients with haematological malignancies or aplastic anaemia: Analysis of 50 cases Polydoros Tofas a , Anna Skiada a , Maria Angelopoulou b , Nikolaos Sipsas c , Ioanna Pavlopoulou a , Sofia Tsaousi d , Maria Pagoni e , Maria Kotsopoulou f , Stavroula Perlorentzou f , Anastasia Antoniadou g , Maria Pirounaki h , Athanasios Skoutelis d , George L. Daikos a,∗ a First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece b Department of Hematology, National and Kapodistrian University of Athens, Athens, Greece c Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece d Fifth Department of Medicine, Evangelismos Hospital, Athens, Greece e Department of Hematology, Evangelismos Hospital, Athens, Greece f Department of Hematology, Metaxa Hospital, Piraeus, Greece g Fourth Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece h Department of Medicine, Hippokrateion Hospital, Athens, Greece a r t i c l e i n f o Article history: Received 20 October 2015 Accepted 25 January 2016 Keywords: Carbapenemase Klebsiella Neutropenia Infection a b s t r a c t Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) are currently among the most important noso- comial pathogens in many geographic regions. A retrospective study was conducted between 2010 and 2014 in four hospitals located in a high-prevalence area (Athens, Greece) to describe the clinical fea- tures, treatment and outcomes of neutropenic patients with haematological diseases complicated with CP-Kp bloodstream infections. A total of 50 patients were identified, including 48 with haematologi- cal malignancies and 2 with aplastic anaemia. All patients had neutropenia (<500 cells/mm 3 ), of whom 40 had <100 neutrophils/mm 3 . The probable source of bacteraemia was identified in 9 patients; in the remaining 41 patients the bacteraemia was considered primary. For definitive treatment, 30 patients received combination therapy (two or more active drugs), 10 received monotherapy (one active drug) and 4 received therapy with no active drug; the remaining 6 patients died within 48 h after the onset of bacteraemia. The 14-day all-cause mortality rate was 50%, 38% and 33% for those who received one, two or three active drugs respectively. In the Cox proportional hazards model, unresolved neutropenia [hazard ratio (HR) = 19.28, 95% confidence interval (CI) 2.31–160.69; P = 0.006], septic shock (HR = 3.04, 95% CI 1.06–8.78; P = 0.04) and treatment with one active drug (HR for monotherapy versus combination therapy = 3.95, 95% CI 1.23–12.65; P = 0.02) were independent predictors of death, whilst combination therapy was associated with lower mortality. These findings may assist physicians in making treatment decisions for neutropenic patients with CP-Kp infections. © 2016 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. 1. Introduction Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) has been established as an important nosocomial pathogen in many geographic areas [1]. Whilst CP-Kp can affect any patient with sig- nificant healthcare exposure in an endemic setting, they mainly ∗ Corresponding author. Tel.: +30 210 745 6843; fax: +30 213 206 1795. E-mail address: gdaikos@med.uoa.gr (G.L. Daikos). cause serious infections in critically ill patients. These infections are associated with increased morbidity and mortality, particularly in patients with severe underlying diseases and co-morbidities [1]. Recent reports have shown that expansion of these organisms into immunosuppressed patients represents a challenging problem in terms of outcome and management [2–5]. The dearth of effective treatment against CP-Kp infections, in conjunction with prolonged neutropenia and other immunological defects observed in patients with haematological malignancies, may make the outcome even worse. http://dx.doi.org/10.1016/j.ijantimicag.2016.01.011 0924-8579/© 2016 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.