title: Double-carbapenem combination as salvage therapy for untreatable infections by KPC-2-producing Klebsiella pneumoniae.
abstract: We report our experience using the double-carbapenem combination as salvage therapy for patients with untreatable infections caused by KPC-2- producing Klebsiella pneumoniae. A total of 27 patients in two institutions in Athens, Greece suffering from complicated urinary tract infections (16) with or without secondary bacteraemia (four and 12 respectively), primary (six) or catheter-related bloodstream infections (two), HAP or VAP (two) and external ventricular drainage infection (one) were treated exclusively with ertapenem and high-dose prolonged infusion meropenem because in-vitro active antimicrobials were unavailable (19) or failed (four) or were contraindicated (six). Most patients presented with severe infections with median APACHE II score of 17 and 11 of those patients (40.7%) had severe sepsis (five) or septic shock (six). The clinical and microbiological success was 77.8 and 74.1% respectively. Crude mortality was 29.6% with attributable mortality of 11.1%. Adverse events, none of them severe, were reported in four patients (14.8%). The double-carbapenem combination as an exclusive regimen represents a safe and valid salvage therapy for untreatable infections by extensively- or pandrug-resistant KPC-producing K.pneumoniae.
authors.affiliation: 4th Department of Internal Medicine, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Chaidari, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Souli
authors.affiliation: 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece, PO:15123.
authors.forename: I
authors.initials: I
authors.lastname: Karaiskos
authors.affiliation: 1st Department of Internal Medicine, Konstantopoulio General Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Masgala
authors.affiliation: 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece, PO:15123.
authors.forename: L
authors.initials: L
authors.lastname: Galani
authors.affiliation: 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece, PO:15123.
authors.forename: E
authors.initials: E
authors.lastname: Barmpouti
authors.affiliation: 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece, PO:15123. e.giamarellou@hygeia.gr.
authors.forename: H
authors.initials: H
authors.lastname: Giamarellou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D015780:Carbapenems / Q000008:administration & dosage*; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006115:Greece; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D011446:Prospective Studies; D016879:Salvage Therapy / Q000379:methods*; D013845:Thienamycins / Q000008:administration & dosage; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D013845:Thienamycins; D001618:beta-Lactamases; C547585:beta-lactamase KPC-2, Klebsiella pneumoniae; D000077731:Meropenem