Carbapenemase-Producing Klebsiella pneumoniae Bloodstream Infections: Lowering Mortality by Antibiotic Combination Schemes and the Role of Carbapenems
Carbapenemase-Producing Klebsiella pneumoniae Bloodstream Infections: Lowering Mortality by Antibiotic Combination Schemes and the Role of Carbapenems
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DOI：
10.1128/aac.02166-13
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发表时间：
2014-04-01
影响因子：
4.9
通讯作者：
Skoutelis, Athanasios
中科院分区：
文献类型：
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作者：
Daikos, George L.;Tsaousi, Sophia;Skoutelis, Athanasios
产碳青霉烯酶肺炎克雷伯菌(CP-KPS)是目前最重要的医院内致病菌之一。2009年至2010年，在高发地区(希腊雅典)的两家医院进行了一项观察性研究。目的是(I)评估CP-KP血流感染(BSI)患者的临床结果，(Ii)确定死亡率的预测因素，以及(Iii)评估所使用的各种抗生素方案。共有205例CP-KP BSI患者被确认：163例(79.5%)感染KPC或KPC和VIM，42例感染VIM生产者。对于确定的治疗，103例患者接受了联合治疗(两种或两种以上活性药物)，72例患者接受了单一治疗(一种活性药物)，12例患者接受了没有活性药物的治疗。其余18例患者在菌血症发病后48小时内死亡。全死因28天死亡率为40%。接受单一治疗的患者死亡率显著高于联合治疗的患者(44.4%比27.2%；P=0.018)。使用含碳青霉烯类药物的患者死亡率最低(19.3%)。在COX比例风险模型中，最终致命性疾病(危险比[HR]，3.25；95%可信区间[CI]，1.5-7.03；P=0.003)、快速致命性基础疾病的存在(HR，4.2；95%CI，2.19-8.08；P
Carbapenemase-producing Klebsiella pneumoniae strains (CP-Kps) are currently among the most important nosocomial pathogens. An observational study was conducted during 2009 to 2010 in two hospitals located in a high-prevalence area (Athens, Greece). The aims were (i) to evaluate the clinical outcome of patients with CP-Kp bloodstream infections (BSIs), (ii) to identify predictors of mortality, and (iii) to evaluate the various antibiotic schemes employed. A total of 205 patients with CP-Kp BSIs were identified: 163 (79.5%) were infected with KPC or KPC and VIM, and 42 were infected with VIM producers. For definitive treatment, 103 patients received combination therapy (two or more active drugs), 72 received monotherapy (one active drug), and 12 received therapy with no active drug. The remaining 18 patients died within 48 h after the onset of bacteremia. The all-cause 28-day mortality was 40%. A significantly higher mortality rate was observed in patients treated with monotherapy than in those treated with combination therapy (44.4% versus 27.2%; P = 0.018). The lowest mortality rate (19.3%) was observed in patients treated with carbapenem-containing combinations. In the Cox proportion hazards model, ultimately fatal disease (hazards ratio [HR], 3.25; 95% confidence interval [CI], 1.51 to 7.03; P = 0.003), the presence of rapidly fatal underlying diseases (HR, 4.20; 95% CI, 2.19 to 8.08; P