Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Infection and the Impact of Antimicrobial and Adjunctive Therapies
Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Infection and the Impact of Antimicrobial and Adjunctive Therapies
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DOI：
10.1086/592412
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发表时间：
2008-12-01
影响因子：
4.5
通讯作者：
Calfee, David P.
中科院分区：
文献类型：
--
作者：
Patel, Gopi;Huprikar, Shirish;Calfee, David P.
背景耐碳青霉烯类肺炎克雷伯菌是一种新兴的医疗保健相关病原体。描述碳青霉烯类耐药克雷伯菌的流行病学和临床结局。肺炎感染，并确定与此类感染患者死亡率相关的危险因素。西奈山医院，位于纽约市的一家拥有1,171张床位的三级护理教学医院。两个匹配的病例对照研究。在第一个配对病例对照研究中，对碳青霉烯类耐药的克雷伯氏菌病例。肺炎克雷伯菌感染与碳青霉烯敏感的对照患者进行了比较。肺炎感染。在第二个病例对照研究中，对碳青霉烯类耐药的克雷伯菌存活的患者。将肺炎克雷伯菌感染者与未存活者进行比较，以确定与碳青霉烯类耐药肺炎克雷伯菌患者死亡率相关的危险因素。肺炎感染。确定了99例病例患者和99例对照患者。抗碳青霉烯类K.肺炎感染与近期器官或干细胞移植（P = 0.008）、机械通气（P = 0.04）、感染前住院时间较长（P = 0.01）、头孢菌素类（P = 0.02）和碳青霉烯类（P <0.001）暴露独立相关。与对照组相比，病例组患者在住院期间死亡的可能性更高（48%比20%; P <0.001），死于感染的可能性更高（38%比12%; P <0.001）。清除感染病灶（即清创术）与患者生存率独立相关（P = 0.002）。及时使用具有体外活性的抗生素对耐碳青霉烯类抗生素的克雷伯氏菌具有重要意义。肺炎与患者生存率无关。抗碳青霉烯类K.肺炎感染与许多卫生保健相关的危险因素和高死亡率有关。与碳青霉烯类耐药克雷伯氏菌相关的死亡率。肺炎克雷伯氏菌感染和有限的抗生素治疗碳青霉烯耐药的选择。肺炎克雷伯氏菌感染突出了对改进碳青霉烯类耐药克雷伯氏菌检测的需要。肺炎克雷伯氏菌感染，确定有效的预防措施，并开发对碳青霉烯类耐药的肺炎克雷伯氏菌具有可靠临床疗效的新药物。肺炎。
BACKGROUND. Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen.OBJECTIVE. To describe the epidemiology of and clinical outcomes associated with carbapenem-resistant K. pneumoniae infection and to identify risk factors associated with mortality among patients with this type of infection.SETTING. Mount Sinai Hospital, a 1,171-bed tertiary care teaching hospital in New York City.DESIGN. Two matched case-control studies.METHODS. In the first matched case-control study, case patients with carbapenem-resistant K. pneumoniae infection were compared with control patients with carbapenem-susceptible K. pneumoniae infection. In the second case-control study, patients who survived carbapenem-resistant K. pneumoniae infection were compared with those who did not survive, to identify risk factors associated with mortality among patients with carbapenem-resistant K. pneumoniae infection.RESULTS. There were 99 case patients and 99 control patients identified. Carbapenem-resistant K. pneumoniae infection was independently associated with recent organ or stem-cell transplantation (P = .008), receipt of mechanical ventilation (P = .04), longer length of stay before infection (P = .01), and exposure to cephalosporins (P = .02) and carbapenems (P < .001). Case patients were more likely than control patients to die during hospitalization (48% vs 20%; P < .001) and to die from infection (38% vs 12%; P < .001). Removal of the focus of infection (ie, debridement) was independently associated with patient survival (P = .002). The timely administration of antibiotics with in vitro activity against carbapenem-resistant K. pneumoniae was not associated with patient survival.CONCLUSIONS. Carbapenem-resistant K. pneumoniae infection is associated with numerous healthcare-related risk factors and with high mortality. The mortality rate associated with carbapenem- resistant K. pneumoniae infection and the limited antimicrobial options for treatment of carbapenem- resistant K. pneumoniae infection highlight the need for improved detection of carbapenem- resistant K. pneumoniae infection, identification of effective preventive measures, and development of novel agents with reliable clinical efficacy against carbapenem-resistant K. pneumoniae.