Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae.
Clin Microbiol Infect. 2016 Feb 2;
Authors: Falcone M, Russo A, Iacovelli A, Restuccia G, Ceccarelli G, Giordano A, Farcomeni A, Morelli A, Venditti M
Abstract
The aim of this study is to identify factors associated with mortality in ICU patients with KPC-Kp septic shock. A retrospective analysis of ICU patients with KPC-Kp infection and septic shock observed in a large teaching hospital from November 2010 to December 2014 was performed. A total of 111 patients were included in the study. The most frequent source of infection was unknown focus bacteremia in 53 (47.7%) patients. The rate of resistance to colistin was 51.3%; 30-day mortality was reported for 44 (39.6%) patients. Surviving patients were more frequently treated with an initial therapy (within 24 hours) including ≥2 antibiotics displaying in vitro activity against the isolated KPC-Kp strain (41.8% Vs 18.1%, p=0.01), and were also more likely to receive a definitive therapy including ≥2 in vitro active antibiotics (85.1% Vs 15.9%, p<0.001). Cox regression analysis revealed that a colistin-containing antibiotic regimen (Hazard ratio [HR] 0.21, CI 95% 0.05-0.72, p<0.001), use of ≥2 in vitro active antibiotics as definite therapy (HR 0.08, CI 95% 0.02-0.21, p<0.001), and control of removable source of infection (HR 0.14, CI 95% 0.04-0.25, p<0.001) were associated with favorable outcome; colistin-resistance (HR 8.09, CI 95% 3.14-11.23, p=0.001), and intra-abdominal source of infection (HR 2.92, CI 95% 2.11-4.12, p=0.002) were associated with death. In conclusion, use of a definitive therapy with at least 2 antibiotics displaying in vitro activity against the KPC-Kp isolates was the most important determinant of favourable outcome, whilst isolation of colistin-resistant strains was associated with death in septic patients with KPC-Kp infection.
PMID: 26850826 [PubMed - as supplied by publisher]