title: High minimum inhibitory concentration of imipenem as a predictor of fatal outcome in patients with carbapenem non-susceptible Klebsiella pneumoniae.
abstract: Carbapenem resistance in Klebsiella pneumoniae is important because of its increasing prevalence and limited therapeutic options. To investigate the clinical and microbiological characteristics of patients infected or colonized with carbapenem non-susceptible K. pneumoniae (CnsKP) in Taiwan, we conducted a retrospective study at Taipei Veterans General Hospital from January 2012 to November 2013. Carbapenem non-susceptibility was defined as a minimum inhibitory concentration (MIC) of ≥2 mg/L for imipenem or meropenem. A total of 105 cases with CnsKP were identified: 49 patients with infection and 56 patients with colonization. Thirty-one isolates had genes that encoded carbapenemases (29.5%), including K. pneumoniae carbapenemase (KPC)-2 (n = 27), KPC-3 (n = 1), VIM-1 (n = 1) and IMP-8 (n = 2). The in-hospital mortality among patients with CnsKP was 43.8%. A MIC for imipenem ≥16 μg/mL, nasogastric intubation and Acute Physiology and Chronic Health Evaluation II score were independent risk factors for in-hospital mortality for all patients with CnsKP. A MIC for imipenem ≥16 μg/mL was also an independent risk factor for 14-day mortality in patients with CnsKP. In conclusion, a positive culture for CnsKP was associated with high in-hospital mortality. A high imipenem MIC of CnsKP can predispose a patient to a poor prognosis.
authors: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Ping-Feng
authors: PF
authors: Wu
authors: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Chien
authors: C
authors: Chuang
authors: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Chin-Fang
authors: CF
authors: Su
authors: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Yi-Tsung
authors: YT
authors: Lin
authors: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Tainan, Taiwan.
authors: Yu-Jiun
authors: YJ
authors: Chan
authors: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Fu-Der
authors: FD
authors: Wang
authors: Department of Internal Medicine and Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
authors: Yin-Ching
authors: YC
authors: Chuang
authors: Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan.
authors: L Kristopher
authors: LK
authors: Siu
authors: Division of Infectious Diseases, Sijhih Cathy General Hospital, New Taipei City, Taiwan.
authors: Chang-Phone
authors: CP
authors: Fung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D000073182:Carbapenem-Resistant Enterobacteriaceae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D006769:Hospitals, General; D006787:Hospitals, Veterans; D006801:Humans; D015378:Imipenem / Q000494:pharmacology*; D007710:Klebsiella Infections / Q000382:microbiology* / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015378:Imipenem; D001618:beta-Lactamases; C063912:carbapenemase