Risk factors for mortality in patients with ventilator-associated pneumonia caused by carbapenem-resistant Enterobacteriaceae.
BACKGROUND
The ideal therapeutic option for ventilator associated pneumonia caused by carbapenem-resistant Enterobacteriaceae is not defined. The aim of this study was to assess mortality-associated risk factors in patients with VAP by CRE and determine the outcome of several treatment options.


METHODS
This was a retrospective study performed in two tertiary hospitals involving patients with VAP caused by CRE between January 2010 and August 2014. The outcomes were mortality within 30 days of VAP diagnosis and overall mortality during hospital admission. Risk factors for mortality were assessed by comparing variables of survivors and non-survivors.


RESULTS
One hundred and twelve patients with CRE-VAP were included, 73 (65%) male, median age 56 years. The 30-day mortality was 57.1% and the overall hospital mortality was 67%. In the binary logistic regression analysis, only age >50 years was independently associated to increased mortality. Polymyxin was the most used drug (47.5%), followed by tigecycline (29.2%) and aminoglycosides (2.4%). Combined therapy with two active drugs was used by 17 patients (20.8%). No therapeutic option was independently associated to survival. However, combined therapy with two active drugs was superior to the therapy with a single active drug when inappropriate therapy was the comparator (p=0.044). The addition of carbapenem was not associated with increased survival.


CONCLUSIONS
The best therapeutic option for VAP by CRE is still not completely defined, but the therapy with at least two active drugs was superior in this study.
Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil; Hospital Universitário Evangélico de Curitiba, Divisão de Doenças Infecciosas e Parasitárias, Curitiba, PR, Brazil. Electronic address: flptuon@gmail.com.
Felipe F
FF
Tuon
Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil; Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Divisão de Doenças Infecciosas e Controle de Infeções, Curitiba, PR, Brazil.
Maria Esther
ME
Graf
Hospital Universitário Evangélico de Curitiba, Divisão de Doenças Infecciosas e Parasitárias, Curitiba, PR, Brazil.
Alexandre
A
Merlini
Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil; Frischmann Aisengart/DASA Medicina Diagnóstica, Divisão de Microbiologia, Curitiba, PR, Brazil.
Jaime L
JL
Rocha
Hospital Universitário Evangélico de Curitiba, Divisão de Doenças Infecciosas e Parasitárias, Curitiba, PR, Brazil.
Suellen
S
Stallbaum
Laboratório Central do Estado do Paraná (LACEN-PR), Curitiba, PR, Brazil.
Lavinia N
LN
Arend
Pontifícia Universidade Católica do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil.
Roberto
R
Pecoit-Filho
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination / Q000401:mortality; D021902:Enterobacter aerogenes / Q000187:drug effects; D004756:Enterobacteriaceae Infections / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015780:Carbapenems
Carbapenemase-producing Klebsiella pneumoniae; Mortality; Risk factors; Treatment; Ventilator-associated pneumonia