Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae
Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae
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DOI：
10.1016/j.cmi.2016.01.016
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发表时间：
2016-05-01
影响因子：
14.2
通讯作者：
Venditti, M.
中科院分区：
文献类型：
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作者：
Falcone, M.;Russo, A.;Venditti, M.
本研究的目的是确定与重症监护病房产碳青霉烯酶肺炎克雷伯菌患者死亡率相关的因素。肺炎克雷伯氏菌（KPC-Kp）感染性休克。对2010年11月至2014年12月在一家大型教学医院观察到的KPC-Kp感染和脓毒性休克的重症监护室患者进行了回顾性分析。共有111例患者入选本研究。最常见的感染源为不明病灶菌血症53例（47.7%）。粘菌素耐药率为51.3%; 44例患者（39.6%）报告了30天死亡率。存活患者更常接受初始治疗（24小时内），包括两种或多种对分离的KPC-Kp菌株显示体外活性的抗生素（41.8 vs. 18.1%，p 0.01），也更可能接受包括两种或多种体外活性抗生素的确定性治疗（85.1 vs. 15.9%，p < 0.001）。考克斯回归分析显示，含粘菌素的抗生素方案（风险比（HR）0.21，置信区间（CI）95% 0.05-0.72，p < 0.001），使用两种或更多种体外活性抗生素作为明确治疗（HR 0.08，CI 95% 0.02-0.21，p < 0.001）和可移动感染源的控制（HR 0.14，CI 95% 0.04-0.25，p < 0.001）与良好结局相关;粘菌素耐药性（HR 8.09，CI 95% 3.14-11.23，p 0.001）和腹腔内感染源（HR 2.92，CI 95% 2.11-4.12，p 0.002）与死亡相关。总之，使用至少两种对KPC-Kp分离株具有体外活性的抗生素进行确定性治疗是有利结局的最重要决定因素，而粘菌素耐药菌株的分离与KPC-Kp感染脓毒症患者的死亡相关。(C)2016年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
The aim of this study was to identify factors associated with mortality in intensive care unit patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) septic shock. A retrospective analysis of intensive care unit patients with KPC-Kp infection and septic shock observed in a large teaching hospital from November 2010 to December 2014 was performed. A total of 111 patients were included in the study. The most frequent source of infection was unknown-focus bacteraemia in 53 patients (47.7%). The rate of resistance to colistin was 51.3%; 30-day mortality was reported for 44 patients (39.6%). Surviving patients were more frequently treated with an initial therapy (within 24 hours) including two or more antibiotics displaying in vitro activity against the isolated KPC-Kp strain (41.8 vs. 18.1%, p 0.01) and were also more likely to receive a definitive therapy including two or more in vitro active antibiotics (85.1 vs. 15.9%, p < 0.001). Cox regression analysis revealed that a colistin-containing antibiotic regimen (hazard ratio (HR) 0.21, confidence interval (CI) 95% 0.05-0.72, p < 0.001), use of two or more in vitro active antibiotics as definite therapy (HR 0.08, CI 95% 0.02-0.21, p < 0.001) and control of removable source of infection (HR 0.14, CI 95% 0.04-0.25, p < 0.001) were associated with favourable outcome; colistin resistance (HR 8.09, CI 95% 3.14-11.23, p 0.001) and intra-abdominal source of infection (HR 2.92, CI 95% 2.11-4.12, p 0.002) were associated with death. In conclusion, use of a definitive therapy with at least two antibiotics displaying in vitro activity against the KPC-Kp isolates was the most important determinant of favourable outcome, whilst isolation of colistin-resistant strains was associated with death in septic patients with KPC-Kp infection. (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.