Predictors of Mortality in Bloodstream Infections Caused by KPC-Producing Klebsiella pneumoniae: Importance of Combination Therapy.
Clin Infect Dis. 2012 Jul 2;
Authors: Tumbarello M, Viale P, Viscoli C, Trecarichi EM, Tumietto F, Marchese A, Spanu T, Ambretti S, Ginocchio F, Cristini F, Losito AR, Tedeschi S, Cauda R, Bassetti M
Background.Ã¢ÂÂThe spread of Klebsiella pneumoniae (Kp) strains that produce Klebsiella pneumoniae carbapenemases (KPCs) has become a significant problem, and treatment of infections caused by these pathogens is a major challenge for clinicians.Methods.Ã¢ÂÂIn this multicenter retrospective cohort study, conducted in three large Italian teaching hospitals, we examined 125 patients with bloodstream infections (BSIs) caused by KPC-producing Kp isolates (KPC-Kp) diagnosed between 1 January 2010 and 30 June 2011. The outcome measured was death within 30 days of the first positive blood culture. Survivor and non-survivor subgroups were compared to identify predictors of mortality.Results.Ã¢ÂÂThe overall 30-day mortality rate was 41.6%. A significantly higher rate was observed among patients treated with monotherapy (54.3% vs. 34.1% in those who received combined drug therapy, P = 0.02).In logistic regression analysis, 30-day mortality was independently associated with septic shock at BSI onset (odds ratio [OR], 7.17; 95% confidence interval [CI], 1.65 to 31.03; P = 0.008); inadequate initial antimicrobial therapy (OR, 4.17; 95% CI, 1.61 to 10.76; P = 0.003); and high APACHE III scores (OR, 1.04; 95% CI, 1.02 to 1.07; P < 0.001). Post-antibiogram therapy with a combination of tigecycline, colistin, and meropenem was associated with lower mortality (OR, 0.11; 95% CI, 0.02 to 0.69; P = 0.01).Conclusions.Ã¢ÂÂKPC-Kp BSIs are associated with high mortality. For improving survival, combined treatment with two or more drugs with in vitro activity against the isolate, especially those including also a carbapenem, may be more effective than active monotherapy.
PMID: 22752516 [PubMed - as supplied by publisher]