Infections caused by carbapenem-resistant Klebsiella pneumoniae among patients in intensive care units in Greece: a multi-centre study on clinical outcome and therapeutic options

被引:135
作者
Kontopidou, F. [1 ]
Giamarellou, H. [2 ]
Katerelos, P. [1 ]
Maragos, A. [1 ]
Kioumis, I. [3 ]
Trikka-Graphakos, E. [4 ]
Valakis, C. [5 ]
Maltezou, H. C. [1 ]
机构
[1] Hellen Ctr Dis Control & Prevent, Dept Intervent Hlth Care Facil, Athens 15123, Greece
[2] Hygeia Gen Hosp, Dept Internal Med 6, Athens, Greece
[3] Aristotle Univ Thessaloniki, Depertment Pulm Med, Papanikolaou Gen Hosp, GR-54006 Thessaloniki, Greece
[4] Thriasio Gen Hosp, Dept Microbiol, Athens, Greece
[5] Sismanoglio Gen Hosp, Athens, Greece
关键词
Carbapenem-resistance; intensive care unit; Klebsiella pneumoniae; KPC; mortality; METALLO-BETA-LACTAMASE; K.-PNEUMONIAE; TIGECYCLINE RESISTANCE; NEGATIVE BACTERIA; RISK-FACTORS; COLISTIN; IMPACT; ENTEROBACTERIACEAE; MONOTHERAPY; PREDICTORS;
D O I
10.1111/1469-0691.12341
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Infections due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) have emerged as a public health problem worldwide given their spread dynamics and the limited therapeutic options. Our aim was to study the clinical outcome of patients with CR-KP infections in relation to antimicrobial treatment. CR-KP infections that occurred in a 10-month period (September 2009 to June 2010) in patients admitted to 19 intensive care units all over Greece were studied. A total of 127 CR-KP infections were reported. Central venous catheter bacteraemia was the most frequent infection, followed by ventilator-associated pneumonia (39 (30.7%) and 35 (27.6%) cases, respectively). Resistance to colistin, tigecycline, gentamicin and amikacin was detected in 20%, 33%, 21% and 64% of isolates, respectively. Regarding treatment, 107 cases received active treatment, including 1 or 2 active antibiotics in 65 (60.7%) and 42 (39.3%) cases, respectively. The most frequent combination was colistin plus aminoglycoside and tigecycline plus aminoglycoside (17 and 11 cases, respectively). Forty-eight (45.2%) of the cases that received active treatment were considered clinical failures, with 23.5% mortality at 14days. Logistic regression analysis revealed that age 55years, non-immunocompromised patients and patients who received colistin had higher successful response rates, while patients 55years old had lower mortality rates at 14days after the introduction of active treatment. CR-KP infections are associated with a significant clinical failure rate. Colistin remains a valuable antimicrobial agent for treating these infections, while the rise of resistance to the last available antibiotics further limits treatment options.
引用
收藏
页码:O117 / O123
页数:7
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