title: Infections caused by carbapenem-resistant Klebsiella pneumoniae among patients in intensive care units in Greece: a multi-centre study on clinical outcome and therapeutic options.
abstract: Infections due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) have emerged as a public health problem worldwide given their spread dynamics and the limited therapeutic options. Our aim was to study the clinical outcome of patients with CR-KP infections in relation to antimicrobial treatment. CR-KP infections that occurred in a 10-month period (September 2009 to June 2010) in patients admitted to 19 intensive care units all over Greece were studied. A total of 127 CR-KP infections were reported. Central venous catheter bacteraemia was the most frequent infection, followed by ventilator-associated pneumonia (39 (30.7%) and 35 (27.6%) cases, respectively). Resistance to colistin, tigecycline, gentamicin and amikacin was detected in 20%, 33%, 21% and 64% of isolates, respectively. Regarding treatment, 107 cases received active treatment, including 1 or ≥2 active antibiotics in 65 (60.7%) and 42 (39.3%) cases, respectively. The most frequent combination was colistin plus aminoglycoside and tigecycline plus aminoglycoside (17 and 11 cases, respectively). Forty-eight (45.2%) of the cases that received active treatment were considered clinical failures, with 23.5% mortality at 14 days. Logistic regression analysis revealed that age ≤55 years, non-immunocompromised patients and patients who received colistin had higher successful response rates, while patients ≤55 years old had lower mortality rates at 14 days after the introduction of active treatment. CR-KP infections are associated with a significant clinical failure rate. Colistin remains a valuable antimicrobial agent for treating these infections, while the rise of resistance to the last available antibiotics further limits treatment options.
authors.affiliation: Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
authors.forename: F
authors.initials: F
authors.lastname: Kontopidou
authors.forename: H
authors.initials: H
authors.lastname: Giamarellou
authors.forename: P
authors.initials: P
authors.lastname: Katerelos
authors.forename: A
authors.initials: A
authors.lastname: Maragos
authors.forename: I
authors.initials: I
authors.lastname: Kioumis
authors.forename: E
authors.initials: E
authors.lastname: Trikka-Graphakos
authors.forename: C
authors.initials: C
authors.lastname: Valakis
authors.forename: H C
authors.initials: HC
authors.lastname: Maltezou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Carbapenem-resistance; KPC; Klebsiella pneumoniae; intensive care unit; mortality