Critical Care Unit, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.
Infectious Diseases Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil; Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
Int J Antimicrob Agents. 2019 Feb;53(2):152-157. doi: 10.1016/j.ijantimicag.2018.10.010. Epub 2018 Oct 26.
Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) bloodstream infections (BSIs) are related to high mortality rates, and combination therapy has been associated with lower mortality in patients treated mostly with colistin. There is a paucity of studies addressing polymyxin B (PMB) treatment for KPC-KP infections. This was a retrospective cohort study of patients with monomicrobial KPC-KP BSIs. The primary outcome was 30-day mortality. Antimicrobial therapy was defined as empirical (started within the first 48 h) or definitive (initiated after >48 h) and was evaluated as follows: monotherapy (only one in vitro active agent or combination therapy of one in vitro active agent plus one or more in vitro non-active agents); and combination therapy with two or more in vitro active agents. A total of 82 KPC-KP BSIs were included; 40 patients (48.8%) died in the first 30 days. Mortality of patients treated with the combination of two in vitro active antimicrobial agents, mostly PMB plus amikacin, was significantly lower (37.5%) compared with monotherapy (64.7%) (P= 0.01). Combination therapy [adjusted hazard ratio (aHR) = 0.40, 95% confidence interval (CI) 0.22-0.83; P = 0.01] was independently associated with lower 30-day survival when controlled for non-surgical admission (aHR = 2.33, 95% CI 1.14-4.80; P = 0.02) and use of vasoactive drugs (aHR = 7.37, 95% CI 3.01-18.02; P < 0.01). In conclusion, combination therapy with two in vitro active agents, mostly PMB plus amikacin, showed a survival benefit compared with other regimens.
产碳青霉烯酶肺炎克雷伯菌（KPC-KP）血流感染（BSI）与高死亡率相关，联合治疗与接受多粘菌素 B（PMB）治疗的患者死亡率降低有关。目前针对 KPC-KP 感染的 PMB 治疗研究较少。本研究为回顾性队列研究，纳入了单一致病菌 KPC-KP BSI 患者。主要结局为 30 天死亡率。抗菌治疗定义为经验性（在最初 48 小时内开始）或确定性（>48 小时后开始），并评估如下：单药治疗（仅一种体外活性药物或一种体外活性药物加一种或多种体外非活性药物的联合治疗）；和两种或两种以上体外活性药物的联合治疗。共纳入 82 例 KPC-KP BSI；40 例（48.8%）患者在第 30 天内死亡。接受两种体外活性抗菌药物联合治疗（主要为 PMB 加阿米卡星）的患者死亡率明显低于单药治疗（64.7%）（P=0.01）。校正非手术入院（校正危害比[aHR]为 2.33，95%置信区间[CI]为 1.14-4.80；P=0.02）和血管活性药物使用（aHR 为 7.37，95%CI 为 3.01-18.02；P<0.01）后，联合治疗与 30 天生存率降低独立相关。总之，与其他方案相比，两种体外活性药物（主要为 PMB 加阿米卡星）的联合治疗显示出生存获益。
