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14.12.2017 | Original Article | Ausgabe 4/2018

European Journal of Clinical Microbiology & Infectious Diseases 4/2018

Treatment outcome of non-carbapenemase-producing carbapenem-resistant Klebsiella pneumoniae infections: a multicenter study in Taiwan

Zeitschrift:
European Journal of Clinical Microbiology & Infectious Diseases > Ausgabe 4/2018
Autoren:
Chin-Fang Su, Chien Chuang, Yi-Tsung Lin, Yu-Jiun Chan, Jung-Chung Lin, Po-Liang Lu, Ching-Tai Huang, Jann-Tay Wang, Yin-Ching Chuang, L. Kristopher Siu, Chang-Phone Fung
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10096-017-3156-8) contains supplementary material, which is available to authorized users.
Chin-Fang Su and Chien Chuang contributed to this manuscript equally.

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections are associated with high mortality, and experiences with its treatment are usually based on carbapenemase-producing strains. Non-carbapenemase-producing CRKP is of clinical significance, but relevant studies are lacking. This nationwide study aimed to evaluate the outcome of antimicrobial therapy in patients with non-carbapenemase-producing CRKP infections. Patients with non-carbapenemase-producing CRKP infections were enrolled from 16 hospitals during January 2013 to December 2014 in Taiwan. Carbapenem resistance was defined as reduced susceptibility with a minimum inhibitory concentration of ≥2 mg/L for imipenem or meropenem. The resistance mechanisms of CRKP isolates were analyzed, and the clinical data of these patients were collected retrospectively. Independent risk factors of 14-day morality were determined by Cox regression analysis. A total of 99 patients with non-carbapenemase-producing CRKP infections were enrolled, and 14-day mortality was 27.3%. Among 67 patients treated with appropriate antimicrobial therapy, most (n = 61) patients received monotherapy. The 14-day mortality was lower in patients treated with appropriate monotherapy (21.3%) than in those with inappropriate therapy (37.5%). The multivariate regression model identified monotherapy (hazard ratio [HR], 0.30; 95% confidence interval [CI], 0.13–0.71; P = 0.005) as protective factor, and APACHE II scores (HR, 1.09; 95% CI, 1.01–1.18; P = 0.022) as risk factor associated with 14-day mortality. Tigecycline, colistin, and carbapenem were the most commonly used drugs in monotherapy. This study provides evidence supporting the efficacy of monotherapy in the treatment of non-carbapenemase-producing CRKP infections, and provides a future target for antibiotics stewardship for CRKP infection.

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