title: Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens.
abstract: Klebsiella pneumoniae producing Klebsiella pneumoniae carbapenemase (KPC) has been associated with serious infections and high mortality. The optimal antimicrobial therapy for infection due to KPC-producing K. pneumoniae is not well established. We conducted a retrospective cohort study to evaluate the clinical outcome of patients with bacteremia caused by KPC-producing K. pneumoniae. A total of 41 unique patients with blood cultures growing KPC-producing K. pneumoniae were identified at two medical centers in the United States. Most of the infections were hospital acquired (32; 78%), while the rest of the cases were health care associated (9; 22%). The overall 28-day crude mortality rate was 39.0% (16/41). In the multivariate analysis, definitive therapy with a combination regimen was independently associated with survival (odds ratio, 0.07 [95% confidence interval, 0.009 to 0.71], P = 0.02). The 28-day mortality was 13.3% in the combination therapy group compared with 57.8% in the monotherapy group (P = 0.01). The most commonly used combinations were colistin-polymyxin B or tigecycline combined with a carbapenem. The mortality in this group was 12.5% (1/8). Despite in vitro susceptibility, patients who received monotherapy with colistin-polymyxin B or tigecycline had a higher mortality of 66.7% (8/12). The use of combination therapy for definitive therapy appears to be associated with improved survival in bacteremia due to KPC-producing K. pneumoniae.
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Zubair A
authors.initials: ZA
authors.lastname: Qureshi
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
authors.forename: Brian A
authors.initials: BA
authors.lastname: Potoski
authors.forename: Mary C
authors.initials: MC
authors.lastname: Kilayko
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandovsky
authors.forename: Emilia
authors.initials: E
authors.lastname: Sordillo
authors.forename: Bruce
authors.initials: B
authors.lastname: Polsky
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Adams-Haduch
authors.forename: Yohei
authors.initials: Y
authors.lastname: Doi
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology*; D001426:Bacterial Proteins / Q000378:metabolism*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004338:Drug Combinations; D001618:beta-Lactamases; C063912:carbapenemase