Antimicrobial treatment of monomicrobial phenotypic carbapenem-resistant Klebsiella pneumoniae bacteremia: Two are better than one
Backgrounds: Infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) are emerging worldwide. The optimal treatment for CRKP infections is challenging for clinicians because therapeutic agents are greatly limited. Material and methods: A retrospective study of CRKP monomicrobial bacter...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-12-01
|
| Series: | Journal of Microbiology, Immunology and Infection |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1684118221001882 |
| _version_ | 1797995176899117056 |
|---|---|
| author | Wen-Chia Tsai Ling-Shan Syue Wen-Chien Ko Ching-Lung Lo Nan-Yao Lee |
| author_facet | Wen-Chia Tsai Ling-Shan Syue Wen-Chien Ko Ching-Lung Lo Nan-Yao Lee |
| author_sort | Wen-Chia Tsai |
| collection | DOAJ |
| description | Backgrounds: Infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) are emerging worldwide. The optimal treatment for CRKP infections is challenging for clinicians because therapeutic agents are greatly limited. Material and methods: A retrospective study of CRKP monomicrobial bacteremia was conducted at a medical center between 2010 and 2016. The use of at least one or more drugs with in vitro activity against the blood isolates was defined as appropriate combination therapy. The logistic regression model and propensity score analysis was used to assess clinical effects of therapeutic strategies. The 30-day crude mortality was the primary end point. Results: Two hundred and three patients were eligible and the 30-day mortality rate was 37.9% (77 patients). As compared with monotherapy, empirical (11.6 vs. 57.3%, p < .001) or definitive (26.5% vs. 48.6%, p = .001) combination antibiotic therapy showed a lower 30-day mortality rate independently. The propensity score analysis showed that those receiving combination therapy had less clinical (p ≤ .001) or microbiological failure (p = .003) and a lower 30-day mortality rate (p < .001). Among various regimens of definitive therapy, the 30-day mortality rate was the lowest among patients with appropriate combination therapy 23.6%, (p < .001; by log rank test). The primary outcome was similar in those with definitive carbapenem-containing and carbapenem-sparing combination regimens (p = .81). The presence or absence of carbapenemase production did not affect the mortality rate (p = .26). Conclusion: Combination therapy, regardless of carbapenem-containing or carbapenem-sparing regimens, was associated with a favorable outcome. |
| first_indexed | 2024-04-11T09:56:19Z |
| format | Article |
| id | doaj.art-7314bb8e34dc4746a6e0437ef3006b5e |
| institution | Directory Open Access Journal |
| issn | 1684-1182 |
| language | English |
| last_indexed | 2024-04-11T09:56:19Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Microbiology, Immunology and Infection |
| spelling | doaj.art-7314bb8e34dc4746a6e0437ef3006b5e2022-12-22T04:30:33ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822022-12-0155612191228Antimicrobial treatment of monomicrobial phenotypic carbapenem-resistant Klebsiella pneumoniae bacteremia: Two are better than oneWen-Chia Tsai0Ling-Shan Syue1Wen-Chien Ko2Ching-Lung Lo3Nan-Yao Lee4Division of Infectious Diseases, Department of Internal Medicine and Tainan, TaiwanDivision of Infectious Diseases, Department of Internal Medicine and Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, TaiwanDivision of Infectious Diseases, Department of Internal Medicine and Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, TaiwanDivision of Infectious Diseases, Department of Internal Medicine and Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Corresponding author. Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, 704, Tainan, Taiwan. Fax: +886 6 2752038.Division of Infectious Diseases, Department of Internal Medicine and Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Corresponding author. Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, 704, Tainan, Taiwan. Fax: +886 6 2752038.Backgrounds: Infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) are emerging worldwide. The optimal treatment for CRKP infections is challenging for clinicians because therapeutic agents are greatly limited. Material and methods: A retrospective study of CRKP monomicrobial bacteremia was conducted at a medical center between 2010 and 2016. The use of at least one or more drugs with in vitro activity against the blood isolates was defined as appropriate combination therapy. The logistic regression model and propensity score analysis was used to assess clinical effects of therapeutic strategies. The 30-day crude mortality was the primary end point. Results: Two hundred and three patients were eligible and the 30-day mortality rate was 37.9% (77 patients). As compared with monotherapy, empirical (11.6 vs. 57.3%, p < .001) or definitive (26.5% vs. 48.6%, p = .001) combination antibiotic therapy showed a lower 30-day mortality rate independently. The propensity score analysis showed that those receiving combination therapy had less clinical (p ≤ .001) or microbiological failure (p = .003) and a lower 30-day mortality rate (p < .001). Among various regimens of definitive therapy, the 30-day mortality rate was the lowest among patients with appropriate combination therapy 23.6%, (p < .001; by log rank test). The primary outcome was similar in those with definitive carbapenem-containing and carbapenem-sparing combination regimens (p = .81). The presence or absence of carbapenemase production did not affect the mortality rate (p = .26). Conclusion: Combination therapy, regardless of carbapenem-containing or carbapenem-sparing regimens, was associated with a favorable outcome.http://www.sciencedirect.com/science/article/pii/S1684118221001882Carbapenem-resistantKlebsiella pneumoniaePhenotypeBacteremiaCombination therapyMICs |
| spellingShingle | Wen-Chia Tsai Ling-Shan Syue Wen-Chien Ko Ching-Lung Lo Nan-Yao Lee Antimicrobial treatment of monomicrobial phenotypic carbapenem-resistant Klebsiella pneumoniae bacteremia: Two are better than one Journal of Microbiology, Immunology and Infection Carbapenem-resistant Klebsiella pneumoniae Phenotype Bacteremia Combination therapy MICs |
| title | Antimicrobial treatment of monomicrobial phenotypic carbapenem-resistant Klebsiella pneumoniae bacteremia: Two are better than one |
| title_full | Antimicrobial treatment of monomicrobial phenotypic carbapenem-resistant Klebsiella pneumoniae bacteremia: Two are better than one |
| title_fullStr | Antimicrobial treatment of monomicrobial phenotypic carbapenem-resistant Klebsiella pneumoniae bacteremia: Two are better than one |
| title_full_unstemmed | Antimicrobial treatment of monomicrobial phenotypic carbapenem-resistant Klebsiella pneumoniae bacteremia: Two are better than one |
| title_short | Antimicrobial treatment of monomicrobial phenotypic carbapenem-resistant Klebsiella pneumoniae bacteremia: Two are better than one |
| title_sort | antimicrobial treatment of monomicrobial phenotypic carbapenem resistant klebsiella pneumoniae bacteremia two are better than one |
| topic | Carbapenem-resistant Klebsiella pneumoniae Phenotype Bacteremia Combination therapy MICs |
| url | http://www.sciencedirect.com/science/article/pii/S1684118221001882 |
| work_keys_str_mv | AT wenchiatsai antimicrobialtreatmentofmonomicrobialphenotypiccarbapenemresistantklebsiellapneumoniaebacteremiatwoarebetterthanone AT lingshansyue antimicrobialtreatmentofmonomicrobialphenotypiccarbapenemresistantklebsiellapneumoniaebacteremiatwoarebetterthanone AT wenchienko antimicrobialtreatmentofmonomicrobialphenotypiccarbapenemresistantklebsiellapneumoniaebacteremiatwoarebetterthanone AT chinglunglo antimicrobialtreatmentofmonomicrobialphenotypiccarbapenemresistantklebsiellapneumoniaebacteremiatwoarebetterthanone AT nanyaolee antimicrobialtreatmentofmonomicrobialphenotypiccarbapenemresistantklebsiellapneumoniaebacteremiatwoarebetterthanone |