title: Gentamicin therapy for sepsis due to carbapenem-resistant and colistin-resistant Klebsiella pneumoniae.
abstract: OBJECTIVE
  Antimicrobial therapy for sepsis caused by carbapenem- and colistin-resistant Klebsiella pneumoniae is not well established. We hypothesized that the early use of gentamicin in cases due to susceptible organisms would decrease the crude mortality rate of this infection.
  
  
  METHODS
  This retrospective cohort study examined 50 cases of sepsis caused by carbapenem-resistant K. pneumoniae occurring between June 2012 and February 2013 during an outbreak of K. pneumoniae ST512 producing KPC-3, SHV-11 and TEM-1. Survival curves categorized by the use of gentamicin were constructed using the Kaplan-Meier method and compared using the log-rank test. Eight multivariate models using Cox regression were designed to study the risk factors for mortality and test the hypothesis.
  
  
  RESULTS
  The 30 day crude mortality rate was 38%. The use of targeted gentamicin was associated with reduced mortality (20.7% versus 61.9%, P = 0.02). In all multivariate regression models, the use of gentamicin was independently associated with lower mortality until Day 30 (HR 0.17-0.29, P = 0.03-0.002 depending on the model) after controlling for other potential confounding variables such as age, optimal treatment, renal function, severity of infection, underlying disease, use of tigecycline and previous hospitalization.
  
  
  CONCLUSIONS
  Gentamicin reduced the mortality from sepsis caused by this K. pneumoniae ST512 clone producing KPC-3, SHV-11 and TEM-1.
authors.affiliation: Clinic Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Córdoba, Córdoba, Spain.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Gonzalez-Padilla
authors.affiliation: Clinic Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Córdoba, Córdoba, Spain Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain julian.torre.sspa@juntadeandalucia.es.
authors.forename: Julián
authors.initials: J
authors.lastname: Torre-Cisneros
authors.affiliation: Intensive Care Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Rivera-Espinar
authors.affiliation: Intensive Care Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pontes-Moreno
authors.affiliation: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: López-Cerero
authors.affiliation: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual
authors.affiliation: Clinic Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Córdoba, Córdoba, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Natera
authors.affiliation: Intensive Care Unit, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Rodríguez
authors.affiliation: Clinic Unit of Preventive Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Salcedo
authors.affiliation: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain Clinic Unit of Microbiology, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-López
authors.affiliation: Clinic Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Córdoba, Córdoba, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero
authors.affiliation: Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015780:Carbapenems / Q000494:pharmacology; D015331:Cohort Studies; D003091:Colistin / Q000494:pharmacology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D005839:Gentamicins; D003091:Colistin
keywords: K. pneumoniae; carbapenem resistance; mortality