Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: Superiority of combination antimicrobial regimens

Zubair A. Qureshi, David L. Paterson, Brian A. Potoski, Mary C. Kilayko, Gabriel Sandovsky, Emilia Sordillo, Bruce Polsky, Jennifer M. Adams-Haduch, Yohei Doi

Research output: Contribution to journalArticle

357 Citations (Scopus)

Abstract

Klebsiella pneumoniae producing Klebsiella pneumoniae carbapenemase (KPC) has been associated with serious infections and high mortality. The optimal antimicrobial therapy for infection due to KPC-producing K. pneumoniae is not well established. We conducted a retrospective cohort study to evaluate the clinical outcome of patients with bacteremia caused by KPC-producing K. pneumoniae. A total of 41 unique patients with blood cultures growing KPC-producing K. pneumoniae were identified at two medical centers in the United States. Most of the infections were hospital acquired (32; 78%), while the rest of the cases were health care associated (9; 22%). The overall 28-day crude mortality rate was 39.0% (16/41). In the multivariate analysis, definitive therapy with a combination regimen was independently associated with survival (odds ratio, 0.07 [95% confidence interval, 0.009 to 0.71], P=0.02). The 28-day mortality was 13.3% in the combination therapy group compared with 57.8% in the monotherapy group (P=0.01). The most commonly used combinations were colistin-polymyxin B or tigecycline combined with a carbapenem. The mortality in this group was 12.5% (1/8). Despite in vitro susceptibility, patients who received monotherapy with colistin-polymyxin B or tigecycline had a higher mortality of 66.7% (8/12). The use of combination therapy for definitive therapy appears to be associated with improved survival in bacteremia due to KPC-producing K. pneumoniae.

Original languageEnglish
Pages (from-to)2108-2113
Number of pages6
JournalAntimicrobial agents and chemotherapy
Volume56
Issue number4
DOIs
Publication statusPublished - 01-04-2012
Externally publishedYes

Fingerprint

Klebsiella pneumoniae
Bacteremia
Mortality
Colistin
Polymyxin B
carbapenemase
Carbapenems
Survival
Therapeutics
Group Psychotherapy
Cross Infection
Infection
Cohort Studies
Multivariate Analysis
Retrospective Studies
Odds Ratio
Confidence Intervals
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Qureshi, Zubair A. ; Paterson, David L. ; Potoski, Brian A. ; Kilayko, Mary C. ; Sandovsky, Gabriel ; Sordillo, Emilia ; Polsky, Bruce ; Adams-Haduch, Jennifer M. ; Doi, Yohei. / Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae : Superiority of combination antimicrobial regimens. In: Antimicrobial agents and chemotherapy. 2012 ; Vol. 56, No. 4. pp. 2108-2113.
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abstract = "Klebsiella pneumoniae producing Klebsiella pneumoniae carbapenemase (KPC) has been associated with serious infections and high mortality. The optimal antimicrobial therapy for infection due to KPC-producing K. pneumoniae is not well established. We conducted a retrospective cohort study to evaluate the clinical outcome of patients with bacteremia caused by KPC-producing K. pneumoniae. A total of 41 unique patients with blood cultures growing KPC-producing K. pneumoniae were identified at two medical centers in the United States. Most of the infections were hospital acquired (32; 78{\%}), while the rest of the cases were health care associated (9; 22{\%}). The overall 28-day crude mortality rate was 39.0{\%} (16/41). In the multivariate analysis, definitive therapy with a combination regimen was independently associated with survival (odds ratio, 0.07 [95{\%} confidence interval, 0.009 to 0.71], P=0.02). The 28-day mortality was 13.3{\%} in the combination therapy group compared with 57.8{\%} in the monotherapy group (P=0.01). The most commonly used combinations were colistin-polymyxin B or tigecycline combined with a carbapenem. The mortality in this group was 12.5{\%} (1/8). Despite in vitro susceptibility, patients who received monotherapy with colistin-polymyxin B or tigecycline had a higher mortality of 66.7{\%} (8/12). The use of combination therapy for definitive therapy appears to be associated with improved survival in bacteremia due to KPC-producing K. pneumoniae.",
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Qureshi, ZA, Paterson, DL, Potoski, BA, Kilayko, MC, Sandovsky, G, Sordillo, E, Polsky, B, Adams-Haduch, JM & Doi, Y 2012, 'Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: Superiority of combination antimicrobial regimens', Antimicrobial agents and chemotherapy, vol. 56, no. 4, pp. 2108-2113. https://doi.org/10.1128/AAC.06268-11

Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae : Superiority of combination antimicrobial regimens. / Qureshi, Zubair A.; Paterson, David L.; Potoski, Brian A.; Kilayko, Mary C.; Sandovsky, Gabriel; Sordillo, Emilia; Polsky, Bruce; Adams-Haduch, Jennifer M.; Doi, Yohei.

In: Antimicrobial agents and chemotherapy, Vol. 56, No. 4, 01.04.2012, p. 2108-2113.

Research output: Contribution to journalArticle

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T1 - Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae

T2 - Superiority of combination antimicrobial regimens

AU - Qureshi, Zubair A.

AU - Paterson, David L.

AU - Potoski, Brian A.

AU - Kilayko, Mary C.

AU - Sandovsky, Gabriel

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AU - Adams-Haduch, Jennifer M.

AU - Doi, Yohei

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N2 - Klebsiella pneumoniae producing Klebsiella pneumoniae carbapenemase (KPC) has been associated with serious infections and high mortality. The optimal antimicrobial therapy for infection due to KPC-producing K. pneumoniae is not well established. We conducted a retrospective cohort study to evaluate the clinical outcome of patients with bacteremia caused by KPC-producing K. pneumoniae. A total of 41 unique patients with blood cultures growing KPC-producing K. pneumoniae were identified at two medical centers in the United States. Most of the infections were hospital acquired (32; 78%), while the rest of the cases were health care associated (9; 22%). The overall 28-day crude mortality rate was 39.0% (16/41). In the multivariate analysis, definitive therapy with a combination regimen was independently associated with survival (odds ratio, 0.07 [95% confidence interval, 0.009 to 0.71], P=0.02). The 28-day mortality was 13.3% in the combination therapy group compared with 57.8% in the monotherapy group (P=0.01). The most commonly used combinations were colistin-polymyxin B or tigecycline combined with a carbapenem. The mortality in this group was 12.5% (1/8). Despite in vitro susceptibility, patients who received monotherapy with colistin-polymyxin B or tigecycline had a higher mortality of 66.7% (8/12). The use of combination therapy for definitive therapy appears to be associated with improved survival in bacteremia due to KPC-producing K. pneumoniae.

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