RT Journal Article
T1 Mortality Associated with Bacteremia Due to Colistin-Resistant Klebsiella pneumoniae with High-Level Meropenem Resistance: Importance of Combination Therapy without Colistin and Carbapenems
A1 Machuca, Isabel
A1 Gutierrez-Gutierrez, Belen
A1 Gracia-Ahufinger, Irene
A1 Rivera Espinar, Francisco
A1 Cano, Angela
A1 Guzman-Puche, Julia
A1 Perez-Nadales, Elena
A1 Natera, Clara
A1 Rodriguez, Marina
A1 Leon, Rafael
A1 Caston, Juan J.
A1 Rodriguez-Lopez, Fernando
A1 Rodriguez-Bano, Jesus
A1 Torre-Cisneros, Julian
K1 Klebsiella pneumoniae
K1 Bacteremia
K1 Carbapenems
K1 Colistin
K1 Mortality
K1 Blood-stream infections
K1 K.-pneumoniae
K1 Enterobacteriaceae
K1 Gentamicin
K1 Predictors
K1 Outcomes
K1 Sepsis
K1 Impact
K1 Definitions
K1 Emergence
AB 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.
PB American Society for Microbiology
SN 0066-4804
YR 2017
FD 2017-05-17
LK http://hdl.handle.net/10668/18999
UL http://hdl.handle.net/10668/18999
LA en
NO Machuca I, Gutiérrez-Gutiérrez B, Gracia-Ahufinger I, Rivera Espinar F, Cano Á, Guzmán-Puche J, et al. Mortality Associated with Bacteremia Due to Colistin-Resistant Klebsiella pneumoniae with High-Level Meropenem Resistance: Importance of Combination Therapy without Colistin and Carbapenems. Antimicrob Agents Chemother. 2017 Jul 25;61(8):e00406-1
NO This study was funded by Planes Nacionales de I D i 2008-2011 and 2013-2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD12/0015/0010 and REIPI RD16/0016/0001; RD16/0016/ 0001; RD16/00167008) and cofinanced by European Development Regional Fund “A way to achieve Europe” and operative program Intelligent Growth 2014-2020. I.M., B.G.-G., I.G.-A., A.C., E.P.-N., C.N., J.J.C., F.R.-L., J.R.-B., and J.T.-C. are members ofthe Spanish Network for Research in Infectious Diseases (REIPI). Conflict of interest: J.R.-B. served as scientific advisor for a research project for AstraZeneca, Pfizer, and InfectoPharm and has been a speaker in unrestricted accred ited educational activities funded by Merck. All other authors declare no conflict of interest.
DS RISalud
RD Apr 18, 2025