title: Adverse hospital outcomes associated with the choice of empiric antibiotics in Klebsiella pneumoniae pneumonia: a retrospective observational study.
abstract: BACKGROUND
  In Malaysia, Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalisation.
  
  
  METHODS
  With concern over its rising microbial resistance, we explored the association of empiric antibiotics choices with the hospital outcomes of patients treated for microbial proven K. pneumoniae pneumonia in an urban-based teaching hospital.
  
  
  RESULTS
  In 313 eligible cases reviewed retrospectively, hospital mortality and requirement for ventilation were 14.3% and 10.8% respectively. Empiric regimes that had in vitro resistance to at least one empiric antibiotic (n = 90) were associated with higher hospital mortality (23.3% vs. 10.8%, P = 0.004) with risk increased by about two-fold [Odds ratio (OR), 2.5; 95% confidence interval (CI), 1.3 to 4.8]. Regimes (n = 84) other than the commonly recommended "standard" regimes (a beta-lactam stable antibiotic with or without a acrolide) were associated with higher ventilation rates (16.7% vs. 8.8%, P = 0.047) with similar increased risk [OR, 2.0; 95% CI, 1.0 to 4.3].
  
  
  CONCLUSIONS
  Our findings reiterate the clinical relevance of in vitro microbial resistance in adult K. pneumoniae pneumonia and support empiric regimes that contain beta-lactam stable antibiotics.
authors.affiliation: IMU Lung Research, International Medical University, Kuala Lumpur, Malaysia. richard_loh@pmc.edu.my
authors.forename: Li Cher
authors.initials: LC
authors.lastname: Loh
authors.forename: Mohd Sani
authors.initials: MS
authors.lastname: Rosdara Masayuni
authors.forename: Abdul Samad
authors.initials: AS
authors.lastname: Nor Izran Hanim
authors.forename: Sree
authors.initials: S
authors.lastname: Raman
authors.forename: Tarmizi
authors.initials: T
authors.lastname: Thayaparan
authors.forename: Shalini
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D017714:Community-Acquired Infections; D024881:Drug Resistance, Bacterial; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D066298:In Vitro Techniques; D007297:Inpatients; D007710:Klebsiella Infections / Q000188:drug therapy*; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008296:Malaysia / Q000453:epidemiology; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents