title: Outcomes and Risk Factors for Mortality among Patients Treated with Carbapenems for Klebsiella spp. Bacteremia.
abstract: BACKGROUND
  Extensive dissemination of carbapenemase-producing Enterobacteriaceae has led to increased resistance among Klebsiella species. Carbapenems are used as a last resort against resistant pathogens, but carbapenemase production can lead to therapy failure. Identification of risk factors for mortality and assessment of current susceptibility breakpoints are valuable for improving patient outcomes.
  
  
  OBJECTIVE
  The objective of this study was to evaluate outcomes and risk factors for mortality among patients treated with carbapenems for Klebsiella spp. bacteremia.
  
  
  METHODS
  Patients hospitalized between 2006 and 2012 with blood cultures positive for Klebsiella spp. who received ≥ 48 hours of carbapenem treatment within 72 hours of positive culture were included in this retrospective study. Patient data were retrieved from electronic medical records. Multivariate logistic regression was used to identify risk factors for 30-day hospital mortality.
  
  
  RESULTS
  One hundred seven patients were included. The mean patient age was 61.5 years and the median APACHE II score was 13 ± 6.2. Overall, 30-day hospital mortality was 9.3%. After adjusting for confounding variables, 30-day mortality was associated with baseline APACHE II score (OR, 1.17; 95% CI, 1.01-1.35; P = 0.03), length of stay prior to index culture (OR, 1.03; 95% CI, 1.00-1.06; P = 0.04), and carbapenem non-susceptible (imipenem or meropenem MIC > 1 mg/L) infection (OR, 9.08; 95% CI, 1.17-70.51; P = 0.04).
  
  
  CONCLUSIONS
  Baseline severity of illness and length of stay prior to culture were associated with 30-day mortality and should be considered when treating patients with Klebsiella bacteremia. These data support the change in carbapenem breakpoints for Klebsiella species.
authors.affiliation: University of Houston, Houston, Texas, United States of America.|Catholic Health Initiatives St. Luke's Health Baylor St. Luke's Medical Center, Houston, Texas, United States of America.
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Biehle
authors.affiliation: University of Houston, Houston, Texas, United States of America.|Catholic Health Initiatives St. Luke's Health Baylor St. Luke's Medical Center, Houston, Texas, United States of America.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Cottreau
authors.affiliation: Northeastern University, Boston, Massachusetts, United States of America.
authors.forename: David J
authors.initials: DJ
authors.lastname: Thompson
authors.affiliation: Northeastern University, Boston, Massachusetts, United States of America.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Filipek
authors.affiliation: Northeastern University, Boston, Massachusetts, United States of America.|Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
authors.forename: J Nicholas
authors.initials: JN
authors.lastname: O'Donnell
authors.affiliation: Catholic Health Initiatives St. Luke's Health Baylor St. Luke's Medical Center, Houston, Texas, United States of America.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Lasco
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Monica V
authors.initials: MV
authors.lastname: Mahoney
authors.affiliation: Northeastern University, Boston, Massachusetts, United States of America.|Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Hirsch
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality*; D015780:Carbapenems / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000401:mortality*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015780:Carbapenems