Infectious Diseases and Clinical Microbiology Department, Kartal Koşuyolu Training and Research Hospital, Istanbul, Turkey.
Infectious Diseases and Clinical Microbiology Department, School of Medicine, Medeniyet University, Istanbul, Turkey.
Int J Infect Dis. 2019 Sep;86:208-211. doi: 10.1016/j.ijid.2019.06.008. Epub 2019 Aug 8.
The aim of this study was to determine the effect of colistin resistance and other predictors on fatality among patients with Klebsiella pneumoniae bloodstream infections (Kp-BSI) and to describe the effect of amikacin and tigecycline on the outcome in an OXA-48 dominant country.
This was a retrospective study performed among patients >16 years of age in a tertiary hospital with 465 beds. All cases had ≥1 positive blood culture for K. pneumoniae 48 h after admission.
Among 210 patients with Kp-BSI, the 30-day mortality rate after isolation of the microorganism was 58%. The rate of carbapenem resistance was higher (64% vs. 38%, p < 0.001) and the colistin minimum inhibitory concentration (MIC) was elevated (7 vs. 4, p < 0.029) among the patients who died. Among the colistin-resistant K. pneumoniae, the rates of OXA-48, ST101, and NDM-1 were 78%, 67%, and 35%, respectively. Amikacin was added to the treatment of 13 patients with carbapenem and colistin-resistant Kp-BSI and 77% survived (p < 0.001). Tigecycline was added to the treatment of 24 patients with carbapenem and colistin-resistant Kp-BSI, and the 30-day mortality rate was 71% (p = 0.576). In the multivariate analysis, carbapenem resistance (odds ratio (OR) 5.2, 95% confidence interval (CI) 2.47-10.9, p < 0.001) and increasing APACHE II score (OR 1.19, 95% CI 1.12-1.26, p < 0.001) were significantly associated with 30-day mortality. The addition of amikacin to the treatment regimen (OR 0.05, 95% CI 0.01-0.23, p < 0.001) was significantly beneficial.
Carbapenem resistance, increasing MIC of colistin, and the lungs as the source of the infection were significantly associated with 30-day mortality. The empirical use of combined active aminoglycosides was found to be beneficial in the treatment of colistin-resistant K. pneumoniae infections.
本研究旨在确定多黏菌素耐药性和其他预测因素对产酸克雷伯菌血流感染（Kp-BSI）患者病死率的影响，并描述在以 OXA-48 为主导的国家中，阿米卡星和替加环素对结局的影响。
这是一项在一家拥有 465 张床位的三级医院中进行的回顾性研究，纳入年龄大于 16 岁的患者。所有患者在入院后 48 小时内均有至少 1 次阳性血培养出产酸克雷伯菌。
在 210 例产酸克雷伯菌血流感染患者中，分离出微生物后 30 天的死亡率为 58%。碳青霉烯类耐药率更高（64%比 38%，p<0.001），多黏菌素最小抑菌浓度（MIC）升高（7 比 4，p<0.029）的患者死亡率更高。在多黏菌素耐药的产酸克雷伯菌中，OXA-48、ST101 和 NDM-1 的检出率分别为 78%、67%和 35%。13 例碳青霉烯类和多黏菌素耐药的产酸克雷伯菌血流感染患者加用阿米卡星治疗，77%存活（p<0.001）。24 例碳青霉烯类和多黏菌素耐药的产酸克雷伯菌血流感染患者加用替加环素治疗，30 天死亡率为 71%（p=0.576）。多变量分析显示，碳青霉烯类耐药（比值比（OR）5.2，95%置信区间（CI）2.47-10.9，p<0.001）和急性生理与慢性健康状况评分系统（APACHE II）评分升高（OR 1.19，95%CI 1.12-1.26，p<0.001）与 30 天死亡率显著相关。加用阿米卡星治疗方案（OR 0.05，95%CI 0.01-0.23，p<0.001）明显有益。
碳青霉烯类耐药、多黏菌素 MIC 升高以及肺部为感染源与 30 天死亡率显著相关。经验性使用联合活性氨基糖苷类药物对治疗多黏菌素耐药产酸克雷伯菌感染有益。
