KLI

Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemaseproducing K. pneumoniae and Escherichia coli bacteremia

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Abstract
ABSTRACT
Background: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales
bacteremia is associated with significant mortality; however, no optimal antibiotic strategy
is available. We aimed to evaluate the clinical outcomes according to the antibiotic regimens
and identify risk factors for mortality in patients with KPC-producing K. pneumoniae and
Escherichia coli bacteremia.
Materials and Methods: This retrospective cohort study included all adult patients with
monomicrobial bacteremia (KPC-producing K. pneumoniae or E. coli) between January 2011
and March 2021 at a 2,700-bed tertiary center.
Results: Ninety-two patients were identified; 7 with E. coli bacteremia, and 85 with K.
pneumoniae bacteremia. Thirty-day mortality was 38.0% (35/92). Non-survivors were more
likely to have had nosocomial infection (88.6% vs. 63.2%, P = 0.01), high APACHE II scores
(mean [interquartile range], 22.0 [14.0 - 28.0] vs. 14.0 [11.0 - 20.5], P <0.001), and septic
shock (51.4% vs. 26.3%, P <0.001) and less likely to have been admitted to the surgical ward
(5.7% vs. 22.8%, P = 0.04), undergone removal of eradicable foci (61.5% vs. 90.6%, P = 0.03),
and received appropriate combination treatment (57.1% vs. 78.9%, P = 0.03) than survivors.
No significant difference in mortality was observed according to combination regimens
including colistin, aminoglycoside, and tigecycline. In multivariable analysis, high APACHE II
scores (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.06 - 1.23, P <0.001),
and appropriate definitive treatment (aOR, 0.25; CI, 0.08 - 0.74, P = 0.01) were independent
risk factors for mortality.
Conclusion: High APACHE II scores and not receiving appropriate definitive treatment
were associated with 30-day mortality. Mortality did not significantly differ according to
combination regimens with conventional drugs such as aminoglycoside and colistin.
Author(s)
서현지배성만김민재정용필김성한이상오최상호김양수정지원
Issued Date
2021
Type
Article
Keyword
Klebsiella pneumoniae CarbapenemaseMortalityKlebsiella pneumoniaeEscherichia coliBacteremia
DOI
10.3947/ic.2021.0083
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8261
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_nrf_kci_oai_kci_go_kr_ARTI_9869896&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Risk%20Factors%20for%20Mortality%20in%20Patients%20with%20Klebsiella%20pneumoniae%20Carbapenemaseproducing%20K.%20pneumoniae%20and%20Escherichia%20coli%20bacteremia&amp;offset=0&amp;pcAvailability=false
Publisher
Infection & Chemotherapy
Location
대한민국
Language
영어
ISSN
2093-2340
Citation Volume
53
Citation Number
3
Citation Start Page
528
Citation End Page
538
Appears in Collections:
Medicine > Medicine
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