title: Carbapenem-resistant Klebsiella pneumoniae bacteremia: factors correlated with clinical and microbiologic outcomes.
abstract: We undertook a retrospective cohort study describing general outcomes and specific factors associated with positive outcomes in bacteremia due to carbapenem-resistant Klebsiella pneumoniae (CRKP). Forty-eight patients were included, of which 42% died at 30 days. Forty-two percent of patients were in septic shock at the time of the first positive blood culture, and 42% were recipients of solid organ transplants. Lack of microbiologic eradication at 7 days was independently associated with 30-day mortality. Adjunctive procedures performed for source control and microbiologic eradication at 7 days were associated with a favorable clinical response at 7 days. Time to initiation and receipt at any time of antimicrobials with in vitro activity against CRKP were not associated with improved survival. Breakthrough bacteremia occurred in 8 cases, all in patients receiving tigecycline. Our data suggest that severity of illness, rapid microbiologic eradication, and source control are crucial factors in the outcomes of patients with CRKP bacteremia.
authors.affiliation: Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: May
authors.initials: M
authors.lastname: Nguyen
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Eschenauer
authors.forename: Monique
authors.initials: M
authors.lastname: Bryan
authors.forename: Kelly
authors.initials: K
authors.lastname: O'Neil
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
authors.forename: Phyllis
authors.initials: P
authors.lastname: Della-Latta
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Kubin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D015780:Carbapenems / Q000494:pharmacology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D016896:Treatment Outcome; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems