Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemaseproducing K. pneumoniae and Escherichia coli bacteremia
- 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)
- 서현지; 배성만; 김민재; 정용필; 김성한; 이상오; 최상호; 김양수; 정지원
- Issued Date
- 2021
- Type
- Article
- Keyword
- Klebsiella pneumoniae Carbapenemase; Mortality; Klebsiella pneumoniae; Escherichia coli; Bacteremia
- 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&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Risk%20Factors%20for%20Mortality%20in%20Patients%20with%20Klebsiella%20pneumoniae%20Carbapenemaseproducing%20K.%20pneumoniae%20and%20Escherichia%20coli%20bacteremia&offset=0&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
-
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