Carbapenem-resistant Klebsiella pneumoniae bacteremia: factors correlated with clinical and microbiologic outcomes.
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.
Nguyen
May
M
Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA.
Eschenauer
Gregory A
GA
Bryan
Monique
M
O'Neil
Kelly
K
Furuya
E Yoko
EY
Della-Latta
Phyllis
P
Kubin
Christine J
CJ
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
D000900:Anti-Bacterial Agents; D015780:Carbapenems