Double carbapenem as a rescue strategy for the treatment of severe carbapenemase-producing Klebsiella pneumoniae infections: a two-center, matched case-control study

Gennaro De Pascale, Luca Montini, Teresa Spanu, Massimo Antonelli, Maria Sole Vallecoccia, Gennaro Martucci, Giovanna Panarello, Daniele Di Carlo, Roberta Di Stefano, Guido Capitanio, Piera Polidori, Antonio Arcadipane

Risultato della ricerca: Contributo in rivistaArticolo in rivista

35 Citazioni (Scopus)

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.
Lingua originaleEnglish
pagine (da-a)173-N/A
RivistaCritical Care
Volume21
DOI
Stato di pubblicazionePubblicato - 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

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