Impact of a bundle intervention to improve the prognosis of KPC-producing Klebsiella pneumoniae infection

OBJECTIVES: This study evaluates the clinical impact of an evidence-based intervention bundle. METHODS: We conducted a prospective, observational, before-and-after study from July 12 to February 22, including 378 patients with KPC-producing Klebsiella pneumoniae (KPC-Kp) infection. The intervention implemented structured quality-of-care indicators, including colonization screening (weekly screening in high-risk wards and screening at admission for patients with prior KPC-Kp colonization and residents from long-term care facilities with high prevalence) and tailored antibiotic strategies (empirical treatment with ceftazidime-avibactam was permitted in colonized patients when clinically indicated). Primary outcome was 30-day all-cause mortality. Multivariate logistic regression and sensitivity analyses identified patient subgroups deriving the greatest benefit. RESULTS: The bundle intervention significantly reduced 30-day mortality (adjusted OR, 0.41; 95% CI, 0.24-0.73; P < 0.01), particularly among patients with bacteremia (OR, 0.31; 95% CI, 0.12-0.84) and appropriate empirical therapy (OR, 0.36; 95% CI, 0.14-0.94). Mortality also decreased significantly in traditionally lower-risk groups, including patients without chronic kidney disease (OR, 0.42; 95% CI, 0.22-0.81), Pitt score ≤2 (OR, 0.12; 95% CI, 0.03-0.52), nonrapidly fatal underlying conditions (OR, 0.33; 95% CI, 0.14-0.77) and INCREMENT-CPE score