Ann Infect Dis Epidemiol | Volume 2, Issue 2 | Research Article | Open Access
Justin Siegfried1, Marco R Scipione1, John Papadopoulos1, Kenneth Inglima2, Maria Aguero- Rosenfeld2 and Yanina Dubrovskaya1*
1Department of Pharmacy, NYU Langone Medical Center, USA
2Department of Microbiology, NYU Langone Medical Center, USA
*Correspondance to: Yanina Dubrovskaya
Fulltext PDFBackground: Recent studies suggest a mortality benefit in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) who received combination therapy with more than one active in vitro agent. CRKP isolates often preserve susceptibility to polymyxins only; therefore, having two active agents may not be an option.
Objective: Evaluate clinical outcomes in CRKP infections who received polymyxin B (PMB) backbone therapy in combination therapy with in vitro active vs. inactive agent(s).
Methods: This single center retrospective cohort study evaluated adult patients with CRKP infections who had presumed sepsis syndrome and received PMB combination therapy ≥48 h.
Results: Among 170 patients with CRKP infections between 2007 and 2014, 62 patients treated with PMB plus active (n=30) or inactive agent(s) (n=32) were included. Median age was 78 (31-93) years, mAPACHE score was 18 (5-29), 76% of patients required intensive care unit (ICU) stay, 60% had septic shock, and these were comparable between groups. The most common infections were respiratory and bacteremia. Agents most frequently used in combination with PMB were tigecycline (60%) and meropenem (34%). In-hospital mortality was 57%. In patients treated with PMB plus in vitro active vs. inactive agent(s) mortality was 67% vs. 47%, P=0.13; microbiologic failure was 39% vs. 52%, P=0.34 and clinical failure was 57% vs. 44%, P=0.45. In multivariate analysis, ICU stay was associated with 11-fold increase in mortality (odds ratio [OR] 11.55; 95% confidence interval [CI] 2.15 to 62.01, P=0.004) and urinary tract infection was associated with survival ([OR] 0.09; 95% [CI] 0.009 to 0.863, P=0.037). Conclusions: In this study mortality, microbiological and clinical failure was comparable between patients with CRKP infections treated with PMB in combination with in vitro active vs. inactive agent(s).
Polymyxin B; in vitro susceptibility; Carbapenem-resistant Klebsiella pneumoniae; Clinical outcomes
Siegfried J, Scipione MR, Papadopoulos J, Inglima K, Aguero- Rosenfeld M, Dubrovskaya Y. Polymyxin B Combination Therapy for the Treatment of Carbapenem- Resistant Klebsiella pneumoniae Infections. Ann Infect Dis Epidemiol. 2017;2(2):1013.