Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia
2
조회
0
다운로드
6
인용
0
참고문헌
키워드
초록
Background: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales bacteremia is associated with significant mortality; however, no optimal antibiotic strategy is available. We aimed to evaluate the clinical outcomes according to the antibiotic regimens and identify risk factors for mortality in patients with KPC-producing K. pneumoniae and Escherichia coli bacteremia. Materials and Methods: This retrospective cohort study included all adult patients with monomicrobial bacteremia (KPC-producing K. pneumoniae or E. coli) between January 2011 and March 2021 at a 2,700-bed tertiary center. Results: Ninety-two patients were identified; 7 with E. coli bacteremia, and 85 with K. pneumoniae bacteremia. Thirty-day mortality was 38.0% (35/92). Non-survivors were more likely to have had nosocomial infection (88.6% vs. 63.2%, P = 0.01), high APACHE II scores (mean [interquartile range], 22.0 [14.0 - 28.0] vs. 14.0 [11.0 - 20.5], P <0.001), and septic shock (51.4% vs. 26.3%, P <0.001) and less likely to have been admitted to the surgical ward (5.7% vs. 22.8%, P = 0.04), undergone removal of eradicable foci (61.5% vs. 90.6%, P = 0.03), and received appropriate combination treatment (57.1% vs. 78.9%, P = 0.03) than survivors. No significant difference in mortality was observed according to combination regimens including colistin, aminoglycoside, and tigecycline. In multivariable analysis, high APACHE II scores (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.06 - 1.23, P <0.001), and appropriate definitive treatment (aOR, 0.25; CI, 0.08 - 0.74, P = 0.01) were independent risk factors for mortality. Conclusion: High APACHE II scores and not receiving appropriate definitive treatment were associated with 30-day mortality. Mortality did not significantly differ according to combination regimens with conventional drugs such as aminoglycoside and colistin.
Abstract
Background: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales bacteremia is associated with significant mortality; however, no optimal antibiotic strategy is available. We aimed to evaluate the clinical outcomes according to the antibiotic regimens and identify risk factors for mortality in patients with KPC-producing K. pneumoniae and Escherichia coli bacteremia. Materials and Methods: This retrospective cohort study included all adult patients with monomicrobial bacteremia (KPC-producing K. pneumoniae or E. coli) between January 2011 and March 2021 at a 2,700-bed tertiary center. Results: Ninety-two patients were identified; 7 with E. coli bacteremia, and 85 with K. pneumoniae bacteremia. Thirty-day mortality was 38.0% (35/92). Non-survivors were more likely to have had nosocomial infection (88.6% vs. 63.2%, P = 0.01), high APACHE II scores (mean [interquartile range], 22.0 [14.0 - 28.0] vs. 14.0 [11.0 - 20.5], P <0.001), and septic shock (51.4% vs. 26.3%, P <0.001) and less likely to have been admitted to the surgical ward (5.7% vs. 22.8%, P = 0.04), undergone removal of eradicable foci (61.5% vs. 90.6%, P = 0.03), and received appropriate combination treatment (57.1% vs. 78.9%, P = 0.03) than survivors. No significant difference in mortality was observed according to combination regimens including colistin, aminoglycoside, and tigecycline. In multivariable analysis, high APACHE II scores (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.06 - 1.23, P <0.001), and appropriate definitive treatment (aOR, 0.25; CI, 0.08 - 0.74, P = 0.01) were independent risk factors for mortality. Conclusion: High APACHE II scores and not receiving appropriate definitive treatment were associated with 30-day mortality. Mortality did not significantly differ according to combination regimens with conventional drugs such as aminoglycoside and colistin.
참고문헌 (32)
- Nordmann P, "Global spread of carbapenemase-producing Enterobacteriaceae", Emerg Infect Dis, 17, pp.1791~1798 (2011)
- Ahn YS, "Epidemiology of carbapenem-resistant Enterobacteriaceae in Korea between 2018 and 2019", Public Health Weekly Report, 14, pp.413~420 (2021)
- Tumbarello M, "Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy", Clin Infect Dis, 55, pp.943~950 (2012)
- Tumbarello M, "Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentre study", J Antimicrob Chemother, 70, pp.2133~2143 (2015)
- Daikos GL, "Carbapenemaseproducing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems", Antimicrob Agents Chemother, 58, pp.2322~2328 (2014)
- Gutiérrez-Gutiérrez B, "Effect of appropriate combination therapy on mortality of patients with bloodstream infections due to carbapenemase-producing Enterobacteriaceae (INCREMENT): a retrospective cohort study", Lancet Infect Dis, 17, pp.726~734 (2017)
- Qureshi ZA, "Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens", Antimicrob Agents Chemother, 56, pp.2108~2113 (2012)
- Tzouvelekis LS, "Treating infections caused by carbapenemase-producing Enterobacteriaceae", Clin Microbiol Infect, 20, pp.862~872 (2014)
- Capone A, "High rate of colistin resistance among patients with carbapenem-resistant Klebsiella pneumoniae infection accounts for an excess of mortality", Clin Microbiol Infect, 19, pp.E23~E30 (2013)
- Spanu T, "In vivo emergence of tigecycline resistance in multidrug-resistant Klebsiella pneumoniae and Escherichia coli", Antimicrob Agents Chemother, 56, pp.4516~4518 (2012)
- Bassetti M, "Multidrug-resistant Klebsiella pneumoniae:challenges for treatment, prevention and infection control", Expert Rev Anti Infect Ther, 16, pp.749~761 (2018)
- Cardoso T, "Classification of healthcare-associated infection: a systematic review 10 years after the first proposal", BMC Med, 12, pp.40~ (2014)
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies: development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- McCABE WR, "Gram-negative bacteremia: II. Clinical, laboratory, and therapeutic observations", Arch Intern Med, 110, pp.856~864 (1962)
- Knaus WA, "APACHE II: a severity of disease classification system", Crit Care Med, 13, pp.818~829 (1985)
- Levy MM, "2001 SCCM", ESICM, ATS, pp.SIS international sepsis definitions conference, Crit Care Med[DOI]
- Horan TC, "CDC", NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting, 2008, pp.36, 309~332
- Rubin LG, "2013 IDSA clinical practice guideline for vaccination of the immunocompromised host", Clin Infect Dis, 58, pp.309~318 (2014)
- Seo H, "Clinical and microbiological analysis of risk factors for mortality in patients with carbapenem-resistant Enterobacteriaceae bacteremia", Int J Antimicrob Agents, 56, pp.106126~
- Martínez ML, "Impact of source control in patients with severe sepsis and septic shock", Crit Care Med, 45, pp.11~19 (2017)
- Tamma PD, "Comparing the outcomes of patients with carbapenemase-producing and non-carbapenemase-producing carbapenem-resistant enterobacteriaceae bacteremia", Clin Infect Dis, 64, pp.257~264 (2017)
- Su CF, "Treatment outcome of non-carbapenemase-producing carbapenem-resistant Klebsiella pneumoniae infections: a multicenter study in Taiwan", Eur J Clin Microbiol Infect Dis, 37, pp.651~659 (2018)
- Clinical and Laboratory Standards Institute (CLSI), "Performance standards for antimicrobial susceptibility testing: 22th informational supplement M100-S22" (2012), CLS
- Cohen Stuart J, "Guideline for phenotypic screening and confirmation of carbapenemases in Enterobacteriaceae", Int J Antimicrob Agents, 36, pp.205~210 (2010)
- Takissian J, "NG-test carba 5 for rapid detection of carbapenemase-producing Enterobacterales from positive blood cultures", Antimicrob Agents Chemother, 63, pp.e00011~e00019 (2019)
- "The Breakpoint tables for interpretation of MICs and zone diameters. Version 11.0"[URL]
- Daikos GL, "Carbapenemase-producing Klebsiella pneumoniae: (when) might we still consider treating with carbapenems?", Clin Microbiol Infect, 17, pp.1135~1141 (2011)
- Seo H, "Comparison of clinical outcomes of patients infected with KPC- and NDM-producing Enterobacterales: a retrospective cohort study", Clin Microbiol Infect, 27, pp.1167.e1~1167.e8 (2021)
- Falcone M, "Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemaseproducing K. pneumoniae", Clin Microbiol Infect, 22, pp.444~450 (2016)
- Shields RK, "Ceftazidime-avibactam is superior to other treatment regimens against carbapenem-resistant Klebsiella pneumoniae bacteremia", Antimicrob Agents Chemother, 61, pp.e00883~e00817 (2017)
- Tumbarello M, "Efficacy of ceftazidimeavibactam salvage therapy in patients with infections caused by Klebsiella pneumoniae carbapenemaseproducing K. pneumoniae", Clin Infect Dis, 68, pp.355~364 (2019)
- Wunderink RG, "Effect and safety of meropenem-vaborbactam versus best-available therapy in patients with carbapenem-resistant Enterobacteriaceae infections: the TANGO II randomized clinical trial", Infect Dis Ther, 7, pp.439~455 (2018)