%0 Journal Article
%A Machuca, Isabel
%A Gutierrez-Gutierrez, Belen
%A Gracia-Ahufinger, Irene
%A Rivera Espinar, Francisco
%A Cano, Angela
%A Guzman-Puche, Julia
%A Perez-Nadales, Elena
%A Natera, Clara
%A Rodriguez, Marina
%A Leon, Rafael
%A Caston, Juan J.
%A Rodriguez-Lopez, Fernando
%A Rodriguez-Bano, Jesus
%A Torre-Cisneros, Julian
%T Mortality Associated with Bacteremia Due to Colistin-Resistant Klebsiella pneumoniae with High-Level Meropenem Resistance: Importance of Combination Therapy without Colistin and Carbapenems
%D 2017
%@ 0066-4804
%U http://hdl.handle.net/10668/18999
%X Combination therapy including colistin and a carbapenem has been found to be associated with lower mortality in the treatment of bloodstream infections (BSI) due to KPC-producing Klebsiella pneumoniae when the isolates show a meropenem or imipenem MIC of = 64 mg/liter) KPC-producing K. pneumoniae diagnosed from July 2012 to February 2016 was performed. The impact of combination therapy on crude 30-day mortality was analyzed by Cox regression using a propensity score as a covariate to control for indication bias and in an inverse probability of treatment weighting (IPTW) cohort. The study sample comprised 104 patients, of which 32 (30.8%) received targeted monotherapy and 72 (69.2%) received targeted combination therapy; none of them received either colistin or a carbapenem. The 30-day crude mortality rate was 30.8% (43.8% in patients treated with monotherapy and 25% in patients receiving combination therapy). In the Cox regression analysis, 30-day mortality was independently associated with septic shock at BSI onset (hazard ratio [HR], 6.03; 95% confidence interval [CI], 1.65 to 21.9; P = 0.006) and admission to the critical care unit (HR, 2.87; 95% CI, 0.99 to 8.27; P = 0.05). Targeted combination therapy was associated with lower mortality only in patients with septic shock (HR, 0.14; 95% CI, 0.03 to 0.67; P = 0.01). These results were confirmed in the Cox regression analysis of the IPTW cohort. Combination therapy is associated with reduced mortality in patients with bacteremia due to colistin-resistant KPC-producing K. pneumoniae with high-level carbapenem resistance in patients with septic shock.
%K Klebsiella pneumoniae
%K Bacteremia
%K Carbapenems
%K Colistin
%K Mortality
%K Blood-stream infections
%K K.-pneumoniae
%K Enterobacteriaceae
%K Gentamicin
%K Predictors
%K Outcomes
%K Sepsis
%K Impact
%K Definitions
%K Emergence
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