碳青霉烯类和多黏菌素类耐药肺炎克雷伯菌引起的败血症的庆大霉素治疗。
Gentamicin therapy for sepsis due to carbapenem-resistant and colistin-resistant Klebsiella pneumoniae.
机构信息
Clinic Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Córdoba, Córdoba, Spain.
Clinic Unit of Infectious Diseases, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Córdoba, Córdoba, Spain Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
出版信息
J Antimicrob Chemother. 2015 Mar;70(3):905-13. doi: 10.1093/jac/dku432. Epub 2014 Oct 25.
OBJECTIVES
Antimicrobial therapy for sepsis caused by carbapenem- and colistin-resistant Klebsiella pneumoniae is not well established. We hypothesized that the early use of gentamicin in cases due to susceptible organisms would decrease the crude mortality rate of this infection.
METHODS
This retrospective cohort study examined 50 cases of sepsis caused by carbapenem-resistant K. pneumoniae occurring between June 2012 and February 2013 during an outbreak of K. pneumoniae ST512 producing KPC-3, SHV-11 and TEM-1. Survival curves categorized by the use of gentamicin were constructed using the Kaplan-Meier method and compared using the log-rank test. Eight multivariate models using Cox regression were designed to study the risk factors for mortality and test the hypothesis.
RESULTS
The 30 day crude mortality rate was 38%. The use of targeted gentamicin was associated with reduced mortality (20.7% versus 61.9%, P = 0.02). In all multivariate regression models, the use of gentamicin was independently associated with lower mortality until Day 30 (HR 0.17-0.29, P = 0.03-0.002 depending on the model) after controlling for other potential confounding variables such as age, optimal treatment, renal function, severity of infection, underlying disease, use of tigecycline and previous hospitalization.
CONCLUSIONS
Gentamicin reduced the mortality from sepsis caused by this K. pneumoniae ST512 clone producing KPC-3, SHV-11 and TEM-1.
目的
碳青霉烯类和黏菌素耐药肺炎克雷伯菌引起的败血症的抗菌治疗尚未得到很好的确立。我们假设，对敏感菌引起的病例早期使用庆大霉素，将降低这种感染的粗死亡率。
方法
本回顾性队列研究调查了 2012 年 6 月至 2013 年 2 月期间爆发的产 KPC-3、SHV-11 和 TEM-1 的 ST512 型肺炎克雷伯菌引起的 50 例败血症病例。使用 Kaplan-Meier 方法构建按庆大霉素使用情况分类的生存曲线，并使用对数秩检验进行比较。设计了 8 个使用 Cox 回归的多变量模型，以研究死亡的危险因素并检验假设。
结果
30 天粗死亡率为 38%。使用靶向庆大霉素与降低死亡率相关（20.7%对 61.9%，P=0.02）。在所有多变量回归模型中，在控制其他潜在混杂变量（如年龄、最佳治疗、肾功能、感染严重程度、基础疾病、替加环素使用和既往住院治疗）后，庆大霉素的使用与 30 天内死亡率降低独立相关（HR 0.17-0.29，取决于模型，P=0.03-0.002）。
结论
庆大霉素降低了由产 KPC-3、SHV-11 和 TEM-1 的 ST512 型肺炎克雷伯菌引起的败血症的死亡率。
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