Unequal burden of COVID-19 in Hungary: a geographical and socioeconomic analysis of the second wave of the pandemic

IntroductionWe describe COVID-19 morbidity, mortality, case fatality and excess death in a country-wide study of municipalities in Hungary, exploring the association with socioeconomic status.MethodsThe spatial distribution of morbidity, mortality and case fatality was mapped using hierarchical Bayesian smoothed indirectly standardised ratios. Indirectly standardised ratios were used to evaluate the association between deprivation and the outcome measures. We looked separately at morbidity and mortality in the 10 districts with the highest and 10 districts with the lowest share of Roma population.ResultsCompared with the national average, the relative incidence of cases was 30%–36% lower in the most deprived quintile but the relative mortality and case fatality were 27%–32% higher. Expressed as incidence ratios relative to the national average, the most deprived municipalities had a relative incidence ratio of 0.64 (CI: 0.62 to 0.65) and 0.70 (CI: 0.69 to 0.72) for males and females, respectively. The corresponding figures for mortality were 1.32 (CI: 1.20 to 1.44) for males and 1.27 (CI: 1.16 to 1.39) for females and for case fatality 1.27 (CI: 1.16 to 1.39) and 1.32 (CI: 1.20 to 1.44) for males and females, respectively. The excess death rate (per 100 000) increased with deprivation levels (least deprived: 114.12 (CI: 108.60 to 119.84) and most deprived: 158.07 (CI: 149.30 to 167.23)). The 10 districts where Roma formed the greatest share of the population had an excess mortality rate 17.46% higher than the average for the most deprived quintile.ConclusionsThose living in more deprived municipalities had a lower risk of being identified as a confirmed COVID-19 case but had a higher risk of death. An inverse association between trends in morbidity and mortality by socioeconomic conditions should be a cause for concern and points to the need for responses, including those involving vaccination, to pay particular attention to inequalities and their causes.

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#53: High Burden of Serious Bacterial Infections in African Children Treated for Cancer

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.019 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

pp. S6-S6

Author(s):

G Naidu ◽

A Izu ◽

R Wainwright ◽

S Poyiadjis ◽

D MacKinnon ◽

...

Keyword(s):

Bacterial Infections ◽

Case Fatality ◽

Morbidity And Mortality ◽

Coagulase Negative Staphylococci ◽

Children With Cancer ◽

Indwelling Catheter ◽

High Burden ◽

African Children ◽

Serious Bacterial Infections ◽

Living With Hiv

Abstract Background Infectious complications in children treated for cancer contribute to their morbidity and mortality. There is a paucity of studies on the incidence, microbiological etiology, risk factors, and outcome of serious bacterial infections in African children treated for cancer. Aim The aim of the study was to delineate the epidemiology of infectious morbidity and mortality in South African children with cancer. Methods This prospective, single-center, longitudinal-cohort study enrolled children one-19 years old hospitalized for cancer treatment at the Paediatric Oncology Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. Children were investigated for infection as part of the standard of care. Results In total, 169 children were enrolled, 82 with hematological malignancy (HM), 87 with a solid tumor (ST), median age was 68.5 months and 10.7% were living with HIV. The incidence (per 100 child-years) of septic episodes (SE) and microbiologically confirmed SE (MSCE) was 101 (138 vs. 70, P < 0.001) and 70.9 (99.1 vs. 47.3; P < 0.001), respectively; higher in children with HM than ST. The incidence of MCSE in children with high-risk HM (137.7) was 4.32-fold greater compared with those with medium-risk HM (30.3; P < 0.001). Children with metastatic ST had a higher incidence (84.4) of MSCE than those with localized ST (33.6; aOR: 2.52; P < 0.001). The presence of an indwelling catheter was 3-fold (P < 0.001) more likely to be associated with MCSE compared with those without. There was no association for age group, nutritional status or HIV-status, and incidence of MCSE. The incidence of gram-positive (GPB) and gram-negative (GNB) SEs was 48.5 and 37.6, respectively, and higher in children with an HM. The most commonly identified GPB were Coagulase-negative Staphylococci, Streptococcus viridans and Enterococcus faecium; while the most common GNB were Escherichia coli, Acinetobacter baumannii, and Pseudomonas species. The median CRP was higher in children with MSCE compared with those with culture-negative SE (CNSE) (116.5 vs. 92; P < 0.001) in both HM (132.5 vs. 117; P < 0.001) and ST (87.5 vs. 46; P < 0.001). The procalcitonin was higher in those with MSCE compared with those with CNSE (2.30 vs. 1.40; P < 0.001) in both HM (2.95 vs. 1.60; P = 0.002) and ST (2.10 vs. 1.20; P < 0.001). The case fatality risk was 40.4%; 80% was attributed to sepsis. Of these, 35 (72.92%) had HM and 34 of the 35 (97.14%) had HR-HM. Children with HM had an overall sepsis CFR of 42.68%. Four (30.77%) of the 13 sepsis-related deaths in STs had metastatic disease and 8 (16.67%) of the total number of sepsis-related deaths were in children living with HIV. There was no association between malnutrition or HIV-positivity and death. The odds of dying from sepsis were higher in children with profound (aOR 3.96; P = 0.004) and prolonged (aOR 3.71; P = 0.011) neutropenia. Pneumonia (58.85% vs. 29.23%; aOR 2.38; P = 0.025) and tuberculosis (70.83% vs. 34.91%; aOR 4.3; P = 0.005) were independently associated with a higher CFR. Conclusion The current study emphasizes the high burden of sepsis in African children treated for cancer, and especially HM, and highlights the association of tuberculosis and pneumonia as independent predictors of death in children with cancer.

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Characterizing a two-pronged epidemic in Mexico of non-communicable diseases and SARS-Cov-2: factors associated with increased case-fatality rates

International Journal of Epidemiology ◽

10.1093/ije/dyab008 ◽

2021 ◽

Author(s):

Eric Monterrubio-Flores ◽

María D Ramírez-Villalobos ◽

Juan Espinosa-Montero ◽

Bernardo Hernandez ◽

Simón Barquera ◽

...

Keyword(s):

Case Fatality ◽

Logistic Models ◽

Communicable Diseases ◽

Chronic Obstructive ◽

Fatality Rate ◽

Younger Adults ◽

Obstructive Pulmonary Disease ◽

Non Communicable Diseases ◽

Risk Of Death ◽

Mexican Adults

Abstract Background People with a previous diagnosis of non-communicable diseases (NCDs) are more likely to develop serious forms of COVID-19 or die. Mexico is the country with the fourth highest fatality rate from SARS-Cov-2, with high mortality in younger adults. Objectives To describe and characterize the association of NCDs with the case-fatality rate (CFR) adjusted by age and sex in Mexican adults with a positive diagnosis for SARS-Cov-2. Methods We studied Mexican adults aged ≥20 years who tested positive for SARS-Cov-2 during the period from 28 February to 31 July 2020. The CFR was calculated and associations with history of NCDs (number of diseases and combinations), severity indicators and type of institution that treated the patient were explored. The relative risk (RR) of death was estimated using Poisson models and CFR was adjusted using logistic models. Results We analysed 406 966 SARS-Cov-2-positive adults. The CFR was 11.2% (13.7% in men and 8.4% in women). The CFR was positively associated with age and number of NCDs (p trend <0.001). The number of NCDs increased the risk of death in younger adults when they presented three or more NCDs compared with those who did not have any NCDs [RR, 46.6; 95% confidence interval (CI), 28.2, 76.9 for women; RR, 16.5; 95% CI, 9.9, 27.3 for men]. Lastly, there was great heterogeneity in the CFR by institution, from 4.6% in private institutions to 18.9% in public institutions. Conclusion In younger adults, higher CFRs were associated with the total number of NCDs and some combinations of type 2 diabetes, chronic kidney disease, chronic obstructive pulmonary disease and cardiovascular disease.

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Influence of the Human Development Index on the Maternal–Perinatal Morbidity and Mortality of Pregnant Women with SARS-CoV-2 Infection: Importance for Personalized Medical Care

Journal of Clinical Medicine ◽

10.3390/jcm10163631 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3631

Author(s):

Yolanda Cuñarro-López ◽

Santiago García-Tizón Larroca ◽

Pilar Pintado-Recarte ◽

Concepción Hernández-Martín ◽

Pilar Prats-Rodríguez ◽

...

Keyword(s):

Pregnant Women ◽

Human Development ◽

Human Development Index ◽

Maternal Morbidity ◽

Tertiary Care ◽

Country Of Origin ◽

Morbidity And Mortality ◽

Inverse Association ◽

Perinatal Morbidity ◽

Development Index

Coronavirus disease-19 (COVID-19) is perhaps the most worrisome pandemic in the 21st century, having entailed devastating consequences for the whole society during the last year. Different studies have displayed an existing association between pregnancy and COVID-19 severity due to the various physiological changes that occur during gestation. Recent data identified maternal country of origin as an important determinant of COVID-19 presentation in pregnant women. However, the explanation of this fact remains to be fully elucidated. Therefore, the purpose of this work is to analyze the possible relationship between Human Development Index (HDI) of maternal country of origin with the morbimortality of pregnant women and their newborns. Here, we conducted a multicentric, ambispective, observational case-control study (1:1 ratio) and compare with the HDI of each country (group 1—very high HDI, group 2—high HDI, group 3—medium HDI, and group 4—low HDI). In total, 1347 pregnant women with confirmed SARV-CoV-2 infection (cases) were enrolled, and each was paired with one control to give a total number of 2694 participants from 81 tertiary care centers. Among the women with SARS-CoV-2 infection, more cases were produced of perinatal mortality, overall maternal morbidity, COVID-19 maternal morbidity, C-sections, hypertensive maternal morbidity, and perinatal morbidity. Our results described an inverse association between HDI and maternofetal morbidity and mortality. Moreover, the countries with an HDI lower than 1 showed higher rates of patients with maternal COVID-19-related morbidity (6.0% vs. 2.4%, p < 0.001), a need for oxygen therapy (4.7% vs. 1.8%, p < 0.001), and maternal ICU admission (2.6% vs. 1.0%, p = 0.007). Compared to other risk factors such as overweight, obesity, preexisting and obstetric comorbidities, HDI emerged as an independent risk factor explaining much of the increased maternal–perinatal morbidity and mortality detected in our group of cases. Further research is needed to establish to confirm the real impact of this factor and its components on pregnancy outcomes.

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Intestinal Perforations Associated With a High Mortality and Frequent Complications During an Epidemic of Multidrug-resistant Typhoid Fever in Blantyre, Malawi

Clinical Infectious Diseases ◽

10.1093/cid/ciaa405 ◽

2020 ◽

Vol 71 (Supplement_2) ◽

pp. S96-S101

Author(s):

Franziska Olgemoeller ◽

Jonathan J Waluza ◽

Dalitso Zeka ◽

Jillian S Gauld ◽

Peter J Diggle ◽

...

Keyword(s):

Typhoid Fever ◽

Low Income ◽

Intestinal Perforation ◽

Bowel Perforation ◽

Temporal Trends ◽

Case Fatality ◽

Salmonella Typhi ◽

Outcome Data ◽

Morbidity And Mortality ◽

Abdominal Viscus

Abstract Background Typhoid fever remains a major source of morbidity and mortality in low-income settings. Its most feared complication is intestinal perforation. However, due to the paucity of diagnostic facilities in typhoid-endemic settings, including microbiology, histopathology, and radiology, the etiology of intestinal perforation is frequently assumed but rarely confirmed. This poses a challenge for accurately estimating burden of disease. Methods We recruited a prospective cohort of patients with confirmed intestinal perforation in 2016 and performed enhanced microbiological investigations (blood and tissue culture, plus tissue polymerase chain reaction [PCR] for Salmonella Typhi). In addition, we used a Poisson generalized linear model to estimate excess perforations attributed to the typhoid epidemic, using temporal trends in S. Typhi bloodstream infection and perforated abdominal viscus at Queen Elizabeth Central Hospital from 2008–2017. Results We recruited 23 patients with intraoperative findings consistent with intestinal perforation. 50% (11/22) of patients recruited were culture or PCR positive for S. Typhi. Case fatality rate from typhoid-associated intestinal perforation was substantial at 18% (2/11). Our statistical model estimates that culture-confirmed cases of typhoid fever lead to an excess of 0.046 perforations per clinical typhoid fever case (95% CI, .03–.06). We therefore estimate that typhoid fever accounts for 43% of all bowel perforation during the period of enhanced surveillance. Conclusions The morbidity and mortality associated with typhoid abdominal perforations are high. By placing clinical outcome data from a cohort in the context of longitudinal surgical registers and bacteremia data, we describe a valuable approach to adjusting estimates of the burden of typhoid fever.

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Endovascular Therapy for Acute Mesenteric Ischemia: An NSQIP Analysis

The American Surgeon ◽

10.1177/000313481508101131 ◽

2015 ◽

Vol 81 (11) ◽

pp. 1170-1176 ◽

Cited By ~ 11

Author(s):

Bernardino C. Branco ◽

Miguel F. Montero-Baker ◽

Hassan Aziz ◽

Zachary Taylor ◽

Joseph L. Mills

Keyword(s):

Endovascular Therapy ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Morbidity And Mortality ◽

High Morbidity ◽

Improvement Program ◽

Risk Of Death ◽

Transfusion Requirements ◽

Emergency Surgical Intervention ◽

The Impact

Acute mesenteric ischemia (AMI) continues to carry high morbidity and mortality. Endovascular strategies have been increasingly used in the management of AMI. The purpose of this study was to evaluate the impact of endovascular therapy on outcomes of patients with AMI. The National Surgical Quality Improvement Program database was queried to identify all patients requiring emergency surgical intervention for AMI. Demographics, clinical data, interventions, and outcomes were extracted. Patients were compared according to treatment (endovascular versus hybrid versus open revascularization). Over the six-year study period, a total of 439 patients were found to have AMI [27 (6.2%) endovascular, 23 (5.2%) hybrid, and 389 (88.6%) open revascularization]. A total of 16 (59.3%) patients in the endovascular group avoided laparotomy. There was a trend toward lower transfusion requirements (intraoperative transfusion: 3.7% for endovascular vs 17.4% for hybrid vs 19.3% for open, adjusted. P = 0.127) and complications in particular pneumonia (22.2% vs 39.1% vs 27.8%, respectively, Adj. P = 0.392) and sepsis (25.9% vs 21.7% vs 35.5%, adjusted P = 0.260). Endovascular therapy was associated with a 2.5-fold decrease in the risk of death [odds ratio, 95% confidence interval: 0.4 (0.2, 0.9), adjusted P = 0.018]. In this analysis of morbidity and mortality, endovascular therapy was associated with decreased need for laparotomy and a trend toward lower transfusion requirements and complications, in particular pneumonia and sepsis. Endovascular first therapy was associated with a 2.5-fold decrease in the risk of death. Further prospective evaluation of these results is warranted.

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Impact of first-wave COronaVIrus disease 2019 infection in patients on haemoDIALysis in Alsace: the observational COVIDIAL study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa170 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1338-1411 ◽

Cited By ~ 3

Author(s):

Nicolas Keller ◽

François Chantrel ◽

Thierry Krummel ◽

Dorothée Bazin-Kara ◽

Anne Laure Faller ◽

...

Keyword(s):

Laboratory Data ◽

Case Fatality ◽

Patient Characteristics ◽

Complete Recovery ◽

High Rate ◽

Atypical Symptoms ◽

Reactive Protein ◽

Risk Of Death ◽

Included Patient

Abstract Background There are only scarce data regarding the presentation, incidence, severity and outcomes of coronavirus disease 2019 (COVID-19) in patients undergoing long-term haemodialysis (HD). A prospective observational study was conducted in eight HD facilities in Alsace, France, to identify clinical characteristics of HD patients with COVID-19 and to assess the determinants of the risk of death. Methods All HD patients tested positive for COVID-19 from 5 March to 28 April 2020 were included. Collected data included patient characteristics, clinical features at diagnosis, laboratory data, treatments and outcomes. Results Among 1346 HD patients, 123 tested positive for COVID-19. Patients had a median age of 77 years (interquartile range 66–83), with a high number of comorbidities (3.2 ± 1.6 per patient). Symptoms were compatible in 63% of patients. Asthenia (77%), diarrhoea (34%) and anorexia (32%) were frequent at diagnosis. The delay between the onset of symptoms and diagnosis, death or complete recovery was 2 (0–5), 7 (4–11) and 32 (26.5–35) days, respectively. Treatment, including lopinavir/ritonavir, hydroxychloroquine and corticosteroids, was administered in 23% of patients. The median C-reactive protein (CRP) and lymphocyte count at diagnosis was 55 mg/L (IQR 25–106) and 690 Ly/µL (IQR 450–960), respectively. The case fatality rate was 24% and determinants associated with the risk of death were body temperature {hazard ratio [HR] 1.96 [95% confidence interval (CI) 1.11–3.44]; P = 0.02} and CRP at diagnosis [HR 1.01 (95% CI 1.005–1.017); P < 0.0001]. Conclusions HD patients were found to be at high risk of developing COVID-19 and exhibited a high rate of mortality. While patients presented severe forms of the disease, they often displayed atypical symptoms, with the CRP level being highly associated with the risk of death.

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GENDER DIFFERENCES IN CHILDHOOD POISONING

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1703657 ◽

2013 ◽

Vol 03 (02) ◽

pp. 069-072

Author(s):

Pratik Vijay Tarvadi ◽

Shankar M. Bakkannavar ◽

Vikram Palimar ◽

G. Pradeep Kumar ◽

Mahabalesh Shetty ◽

...

Keyword(s):

Cross Sectional Study ◽

Morbidity And Mortality ◽

Medical Emergency ◽

High Morbidity ◽

Sectional Study ◽

Cross Sectional ◽

Medical College ◽

Childhood Poisoning ◽

Males And Females ◽

The Difference

Abstract Background: Accidental paediatric poisoning is a common medical emergency and also associated with a high morbidity and mortality in children. In developing countries like India, the poisoning emergencies are becoming a major cause of mortality in infants and toddlers. Among the various studies done on poisoning cases in our country, the study on poisoning is more or less only on adults and hence this study is taken up to understand the number of childhood poisoning cases (based on gender). Method: A ten year record based cross sectional study from January 1999 to December 2008 was conducted at the Department of Forensic Medicine & Toxicology, Kasturba Medical College, Manipal, to understand the magnitude of childhood poisoning cases among males and females at Kasturba Hospital, Manipal. Results: Male children were predominantly affected (male: female::1.32: 1). Most of the poisoning cases occurred at home in both the genders with boy to girl ratio based on percentage in indoor poisoning being 0.92:1 and boy to girl ratio based on percentage in outcome being 1.06:1. Conclusion: Our study examines the difference in place and outcome of poisoning among boys and girls to identify population at risk and give suggestions so as to reduce the morbidity and mortality.

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Analysis of Japanese encephalitis epidemic in western Nepal in 1997

Epidemiology and Infection ◽

10.1017/s0950268801004769 ◽

2001 ◽

Vol 126 (1) ◽

pp. 81-88 ◽

Cited By ~ 19

Author(s):

T. AKIBA ◽

K. OSAKA ◽

S. TANG ◽

M. NAKAYAMA ◽

A. YAMAMOTO ◽

...

Keyword(s):

Japanese Encephalitis ◽

Total Population ◽

Preventive Measures ◽

Case Fatality ◽

Fatality Rate ◽

Southwestern Part ◽

Epidemic Period ◽

Clinical Diagnoses ◽

Males And Females ◽

Children Under 5

We conducted an epidemiological study of a Japanese encephalitis (JE) outbreak in the southwestern part of Nepal in 1997. A high density of JE infections was found and it was estimated that 27·9% the total population were infected with JE virus in the study area. The fatality rate was 13·2% and there was no difference in the fatality rate between males and females over 5 years old. However, the case fatality rate was 2·1 times higher in females than in males (14·6% vs. 6·9%) among children under 5 years of age. Fifty-three blood samples were collected from suspected JE cases during the epidemic period in 1998. Findings for JE specific IgM revealed that clinical diagnoses of JE were serologically confirmed in an average 78% (70–93%) of patients in three collaborating hospitals. These studies demonstrated that JE was highly prevalent in the area and clinical diagnoses were reliable. Effective preventive measures should be taken against this vaccine-preventable disease.

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Mortality, Morbidity, and Prognostic Factors in the Surgical Resection of Brain Metastases: A Contemporary Cohort Study

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1696997 ◽

2020 ◽

Vol 81 (04) ◽

pp. 279-289

Author(s):

Helder Picarelli ◽

Marcelo de Lima Oliveira ◽

Gustavo Nader Marta ◽

Davi J. Fontoura Solla ◽

Manoel Jacobsen Teixeira ◽

...

Keyword(s):

Prognostic Factors ◽

Brain Metastases ◽

Causes Of Death ◽

Cox Regression ◽

Morbidity And Mortality ◽

Carcinomatous Meningitis ◽

Primary Tumor Site ◽

Risk Of Death ◽

Prognostic Indices ◽

The Impact

Abstract Objective Despite advances in systemic therapy and radiotherapy (RT), neurosurgical resection (NSR) remains a mainstay of the treatment of brain metastases (BMs). Although it is unequivocal in instances of diagnostic doubt, radioresistance, and risk of death due to neurologic causes, NSR may be controversial in other situations. Many aspects related to NSR have not yet been well established, and the primary prognostic indices were proposed only in the last decade. This study evaluates the survival and the morbidity, causes of death, prognostic factors, and the impact of RT in patients with BMs treated by NSR in the current era. Methods A total of 200 patients with BMs who were treated by NSR were evaluated sequentially and followed prospectively. We used logistic regression and Cox regression models to identify independent factors associated with mortality at 4 weeks and at 1 year, respectively. Clinical features, morbidity, recurrence, and causes of death were also studied. Results Lung cancer was the most prevalent cancer (36.5%); the median Karnofsky Performance Status (KPS) score was 60. Total resection was achieved in 89%, and adjuvant RT was applied in 63% of the cases. The rates of surgical mortality, morbidity, and mortality at 4 weeks were 1.5%, 17%, and 7.5%, respectively. Systemic infections were the leading cause of death in 62.5% of the cases. The median survival was 5 months, and 34.5% of patients lived > 1 year. The postoperative KPS (KPSpo) score remained unchanged or improved in 94.5% of the cases. In the multivariate analysis, a KPSpo score ≥ 80 and the application of adjuvant RT were associated with a lower risk of death at 12 weeks and at 1 year. Interestingly, the variables of primary tumor site, number of BMs, and presence of carcinomatous meningitis were not significant. Conclusion Morbidity and mortality were high, a third of the patients lived > 1 year, and the KPS score improved or remained unchanged in most cases. Prognostic indices and health conditions were important predictive factors, but the KPSpo score and adjuvant RT were independent variables for survival at 12 weeks and at 1 year. Therefore, new studies are needed to assess the influence of new therapies and specific molecular profiles.

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Biofilm Production by Carbapenem-Resistant Klebsiella pneumoniae Significantly Increases the Risk of Death in Oncological Patients

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2020.561741 ◽

2020 ◽

Vol 10 ◽

Author(s):

Enea Gino Di Domenico ◽

Ilaria Cavallo ◽

Francesca Sivori ◽

Francesco Marchesi ◽

Grazia Prignano ◽

...

Keyword(s):

High Risk ◽

Klebsiella Pneumoniae ◽

Univariate Analysis ◽

Carbapenem Resistance ◽

Morbidity And Mortality ◽

Risk Of Death ◽

Carbapenem Resistant ◽

Biofilm Production ◽

Oncological Patients ◽

The Impact

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a prominent cause of nosocomial infections associated with high rates of morbidity and mortality, particularly in oncological patients. The hypermucoviscous (HMV) phenotype and biofilm production are key factors for CRKP colonization and persistence in the host. This study aims at exploring the impact of CRKP virulence factors on morbidity and mortality in oncological patients. A total of 86 CRKP were collected between January 2015 and December 2019. Carbapenem resistance-associated genes, antibiotic susceptibility, the HMV phenotype, and biofilm production were evaluated. The median age of the patients was 71 years (range 40–96 years). Clinically infected patients were 53 (61.6%), while CRKP colonized individuals were 33 (38.4%). The most common infectious manifestations were sepsis (43.4%) and pneumonia (18.9%), while rectal surveillance swabs were the most common site of CRKP isolation (81.8%) in colonized patients. The leading mechanism of carbapenem resistance was sustained by the KPC gene (96.5%), followed by OXA-48 (2.3%) and VIM (1.2%). Phenotypic CRKP characterization indicated that 55.8% of the isolates were strong biofilm-producers equally distributed between infected (54.2%) and colonized (45.8%) patients. The HMV phenotype was found in 22.1% of the isolates, which showed a significant (P<0.0001) decrease in biofilm production as compared to non-HMV strains. The overall mortality rate calculated on the group of infected patients was 35.8%. In univariate analysis, pneumoniae significantly correlated with death (OR 5.09; CI 95% 1.08–24.02; P=0.04). The non-HMV phenotype (OR 4.67; CI 95% 1.13–19.24; P=0.03) and strong biofilm-producing strains (OR 5.04; CI95% 1.39–18.25; P=0.01) were also associated with increased CRKP infection-related mortality. Notably, the multivariate analysis showed that infection with strong biofilm-producing CRKP was an independent predictor of mortality (OR 6.30; CI 95% 1.392–18.248; P=0.004). CRKP infection presents a high risk of death among oncological patients, particularly when pneumoniae and sepsis are present. In infected patients, the presence of strong biofilm-producing CRKP significantly increases the risk of death. Thus, the assessment of biofilm production may provide a key element in supporting the clinical management of high-risk oncological patients with CRKP infection.

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