TY - JOUR
TI - Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: Lowering mortality by antibiotic combination schemes and the role of carbapenems
AU - Daikos, G.L.
AU - Tsaousi, S.
AU - Tzouvelekis, L.S.
AU - Anyfantis, I.
AU - Psichogiou, M.
AU - Argyropoulou, A.
AU - Stefanou, I.
AU - Sypsa, V.
AU - Miriagou, V.
AU - Nepka, M.
AU - Georgiadou, S.
AU - Markogiannakis, A.
AU - Goukos, D.
AU - Skoutelis, A.
JO - Antimicrobial Agents and Chemotherapy
PY - 2014
VL - 58
TODO - 4
SP - 2322-2328
PB - American Society for Microbiology
SN - 0066-4804, 1098-6596
TODO - 10.1128/AAC.02166-13
TODO - aminoglycoside antibiotic agent;  antibiotic agent;  carbapenem;  carbapenemase;  colistin;  tigecycline, adult;  aged;  antibiotic therapy;  article;  bacteremia;  bloodstream infection;  cohort analysis;  controlled study;  female;  human;  Klebsiella pneumoniae;  major clinical study;  male;  middle aged;  monotherapy;  mortality;  outcome assessment;  priority journal;  septic shock, Adolescent;  Adult;  Aged;  Aged, 80 and over;  Anti-Bacterial Agents;  Bacterial Proteins;  beta-Lactamases;  Carbapenems;  Female;  Humans;  Kaplan-Meier Estimate;  Klebsiella Infections;  Klebsiella pneumoniae;  Male;  Middle Aged;  Proportional Hazards Models;  Young Adult
TODO - Carbapenemase-producing Klebsiella pneumoniae strains (CP-Kps) are currently among the most important nosocomial pathogens. An observational study was conducted during 2009 to 2010 in two hospitals located in a high-prevalence area (Athens, Greece). The aims were (i) to evaluate the clinical outcome of patients with CP-Kp bloodstream infections (BSIs), (ii) to identify predictors of mortality, and (iii) to evaluate the various antibiotic schemes employed. A total of 205 patients with CP-Kp BSIs were identified: 163 (79.5%) were infected with KPC or KPC and VIM, and 42 were infected with VIM producers. For definitive treatment, 103 patients received combination therapy (two or more active drugs), 72 received monotherapy (one active drug), and 12 received therapy with no active drug. The remaining 18 patients died within 48 h after the onset of bacteremia. The all-cause 28-day mortality was 40%. A significantly higher mortality rate was observed in patients treated with monotherapy than in those treated with combination therapy (44.4% versus 27.2%; P = 0.018). The lowest mortality rate (19.3%) was observed in patients treated with carbapenem-containing combinations. In the Cox proportion hazards model, ultimately fatal disease (hazards ratio [HR], 3.25; 95% confidence interval [CI], 1.51 to 7.03; P = 0.003), the presence of rapidly fatal underlying diseases (HR, 4.20; 95% CI, 2.19 to 8.08; P < 0.001), and septic shock (HR, 2.15; 95% CI, 1.16 to 3.96; P = 0.015) were independent predictors of death. Combination therapy was strongly associated with survival (HR of death for monotherapy versus combination, 2.08; 95% CI, 1.23 to 3.51; P = 0.006), mostly due to the effectiveness of the carbapenem-containing regimens. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
ER -