Abstract
Abstract
BACKGROUND:
Recent reports have suggested the efficacy of a double carbapenem (DC) combination, including ertapenem, for the treatment of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) infections. We aimed to evaluate the clinical impact of such a regimen in critically ill patients.
METHODS:
This case-control (1:2), observational, two-center study involved critically ill adults with a microbiologically documented CR-Kp invasive infection treated with the DC regimen matched with those receiving a standard treatment (ST) (i.e., colistin, tigecycline, or gentamicin).
RESULTS:
The primary end point was 28-day mortality. Secondary outcomes were clinical cure, microbiological eradication, duration of mechanical ventilation and of vasopressors, and 90-day mortality. Forty-eight patients treated with DC were matched with 96 controls. Occurrence of septic shock at infection and high procalcitonin levels were significantly more frequent in patients receiving DC treatment (p < 0.01). The 28-day mortality was significantly higher in patients receiving ST compared with the DC group (47.9% vs 29.2%, p = 0.04). Similarly, clinical cure and microbiological eradication were significantly higher when DC was used in patients infected with CR-Kp strains resistant to colistin (13/20 (65%) vs 10/32 (31.3%), p = 0.03 and 11/19 (57.9%) vs 7/27 (25.9%), p = 0.04, respectively). In the logistic regression and multivariate Cox-regression models, the DC regimen was associated with a reduction in 28-day mortality (OR 0.33, 95% CI 0.13-0.87 and OR 0.43, 95% CI 0.23-0.79, respectively).
CONCLUSIONS:
Improved 28-day mortality was associated with the DC regimen compared with ST for severe CR-Kp infections. A randomized trial is needed to confirm these observational results.
TRIAL REGISTRATION:
ClinicalTrials.gov NCT03094494 . Registered 28 March 2017.
Original language | English |
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Pages (from-to) | 173-N/A |
Journal | Critical Care |
Volume | 21 |
DOIs | |
Publication status | Published - 2017 |
Keywords
- Adult
- Aged
- Anti-Bacterial Agents
- Carbapenems
- Case-Control Studies
- Critically ill patients
- Double carbapenem
- Drug Resistance, Multiple
- Ertapenem
- Female
- Humans
- Infections
- Italy
- Klebsiella Infections
- Klebsiella pneumoniae
- Length of Stay
- Logistic Models
- Male
- Meropenem
- Microbial Sensitivity Tests
- Middle Aged
- Multidrug-resistant bacteria
- Retrospective Studies
- Statistics, Nonparametric
- beta-Lactams