Treatment Outcome of Bacteremia Due to Non–Carbapenemase-producing Carbapenem-Resistant Klebsiella pneumoniae Bacteremia: Role of Carbapenem Combination Therapy

Lee, Nan Yao; Tsai, Chin-Shiang; Syue, Ling Shan; Chen, Po‐Lin; Li, Chia Wen; Li, Ming Chi; Ko, Wen Chien

doi:10.1016/j.clinthera.2020.01.004

Cited by 26 publications

(22 citation statements)

References 36 publications

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“…This study revealed that a higher Pitt bacteremia score was independently associated with 30-day mortality in patients with CRKP BSI. The result was comparable with the study of Shen et al and Xiao et al [ 31 , 32 ] Gomez-Simmonds et al and Lee et al also reported that the patients with Pitt bacteremia score > 4 had significantly higher mortality [ 15 , 17 ] Additionally, our study revealed an association of lower platelet count with higher mortality, which might also reflect the severity of illness [ 33 ]. Some studies used different tools to evaluate the severity of illness at the presence of CRKP BSI, for example, APACHE II score; a higher APACHE II score was reported to be independently associated with 30-day mortality [ 13 , 34 ].…”

Section: Discussionsupporting

confidence: 91%

“…Many studies found that CRKP BSI patients treated with combined antibiotics had better survival outcomes than those treated with monotherapy [ 12 , 13 ]. However, potentially effective regimens are varied across studies and those that are available are very limited [ 14 , 15 , 16 , 17 ]. Since there is no consensus on optimal antimicrobial regimens for CRKP infection, it is crucial to understand the possible risk factors for unfavourable outcomes and potentially optimal antibiotics when treating CRKP BSI patients.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors of 30-Day All-Cause Mortality in Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection

Liu

Tong

Lee

et al. 2021

JPM

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An optimal antimicrobial regimen for the treatment of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is currently unavailable. This study aimed to identify the appropriate antibiotics and the risk factors of all-cause mortality for CRKP BSI patients. This retrospective cohort study included the hospitalized patients with CRKP BSI. Primary outcome was 30-day all-cause mortality. Cox regression analysis was used to evaluate the risk factors of 30-day mortality. A total of 89 patients were included with a 30-day mortality of 52.1%. A total of 52 (58.4%) patients were treated with appropriate antimicrobial regimens and 58 (65.2%) isolates carried blaKPC-2 genes. Microbiologic eradication within 7 days (adjusted hazard ratio [HR] = 0.09, p < 0.001), platelet count (per 1 × 104/mm3, adjusted HR = 0.95, p = 0.002), and Pitt bacteremia scores (adjusted HR = 1.40, p < 0.001) were independently associated with 30-day all-cause mortality. No effective antimicrobial regimens were identified. In conclusion, risk factors of 30-day mortality in patients with CRKP BSI included microbiologic eradication > 7 days, lower platelet count, and a higher Pitt bacteremia score. These findings render a new insight into the clinical landscape of CRKP BSI.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Risk Factors of 30-Day All-Cause Mortality in Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection

Liu

Tong

Lee

et al. 2021

JPM

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“…BSI caused by strain often aggravates the disease, resulting in difficult treatment and poor clinical prognosis. A large number of studies have shown that early identification and early appropriate antibiotic treatment are significantly related to the reduction of mortality (Schwaber and Carmeli, 2008;Daikos et al, 2014;Gomez-Simmonds et al, 2016;Tsala et al, 2019;Lee et al, 2020). Due to the lack of attention to high risk factors, late identification and inadequate antibacterial treatment increases mortality; thus, it is necessary to obtain cultures in the early stage of infection to determine specific pathogens, drug resistance, and reasonable antibiotic treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have discussed BSIs caused by K. Pneumoniae (Daikos et al, 2014;Gomez-Simmonds et al, 2016;Tsala et al, 2019;Gasparrini et al, 2020;Lee et al, 2020). However, the risk factors for drug-resistant bacterial infection and death of patients with bacteremia are still inconsistent among the different studies; thus, these risk factors still need to be further improved and verified in clinical practice (Du et al, 2002;Ben-David et al, 2012;Giannella et al, 2019;Lee et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Clinical Observation and Prognostic Analysis of Patients With Klebsiella pneumoniae Bloodstream Infection

Zhang

Yang

Wang

et al. 2020

Front. Cell. Infect. Microbiol.

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“…BSI induced by these strains often aggravates the disease, resulting in difficult treatment and poor clinical prognosis. A large number of studies have shown that early identification and early appropriate antibiotic treatment are significantly related to the reduction of mortality (16)(17)(18)(19)(20). Due to the lack of attention to high risk factors, late identification and inadequate antibacterial treatment increases mortality; thus, it is necessary to obtain cultures in the early stage of infection to determine specific pathogens, drug resistance, and reasonable antibiotic treatment.…”

Section: Introductionmentioning

confidence: 99%

Clinical observation and prognostic analysis of patients with Klebsiella pneumoniae bloodstream infection

Sun

Zhang

Yang

et al. 2020

Preprint

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Background and Purpose: The clinical prognosis of Klebsiella pneumoniae bloodstream infection is poor, and the prevalence of drug-resistant bacteria makes clinical anti-infective treatment more challenging. This retrospective study evaluated the epidemiological characteristics of patients with Klebsiella pneumoniae, the risk factors for drug-resistant bacterial infection and death, and analyzed treatment options. Methods: Clinical data of 297 patients diagnosed with Klebsiella pneumoniae bacteremia between June 2014 and June 2019 were collected.Results: Intensive care unit hospitalization history, operation history, recent antibiotic use history, mechanical ventilation, and number of days hospitalized before bloodstream infection were found to be independent risk factors for drug-resistant bacterial infection. The risk of death for carbapenem-resistant Klebsiella pneumoniae infection was 2.942 times higher than that for carbapenem-sensitive Klebsiella pneumoniae infection. For extensively drug-resistant Klebsiella pneumoniae bacteremia patients, the mortality rate of combined anti-infective therapy was lower.Conclusions: Clinicians should pay attention to patients with high-risk drug-resistant bacteria infection and administer timely anti-infection treatment. The findings of this study may provide some suggestions for early identification and standardized treatment of patients with Klebsiella pneumoniae bacteremia.

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Treatment Outcome of Bacteremia Due to Non–Carbapenemase-producing Carbapenem-Resistant Klebsiella pneumoniae Bacteremia: Role of Carbapenem Combination Therapy

Cited by 26 publications

References 36 publications

Risk Factors of 30-Day All-Cause Mortality in Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection

Risk Factors of 30-Day All-Cause Mortality in Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection

Clinical Observation and Prognostic Analysis of Patients With Klebsiella pneumoniae Bloodstream Infection

Clinical observation and prognostic analysis of patients with Klebsiella pneumoniae bloodstream infection

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