國家衛生研究院 NHRI:Item 3990099045/10931

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Title:	Predictors of mortality in hospitalized patients with carbapenem-resistant Klebsiella pneumoniae bacteriuria
Authors:	Chuang, C;Su, CF;Lin, YT;Wang, FD;Chuang, YC;Siu, LK;Fung, CP
Contributors:	National Institute of Infectious Diseases and Vaccinology
Abstract:	Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has been increasingly reported worldwide, but few studies address the clinical significance and outcome of antimicro-bial treatment in CRKP bacteriuria. Methods: We retrospectively collected clinical and microbiological data of patients with monomicrobial CRKP bacteriuria from 16 hospitals in Taiwan during 2013 to 2014. Carbapenem resistance was defined as a minimum inhibitory concentration (MIC) of ≥2 mg/L for imipenem or meropenem. The resistance mechanisms were analyzed. Critically ill patients were those with an Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥ 20. Tigecycline was considered as inappropriate therapy regardless of MIC due to low urine concentration. Multivariate Cox regression analysis was used to determine independent risk factors of 14-day and 28-day mortality. Subgroup analysis for critically ill and non-critically ill patients were performed. Results: Of the 126 hospitalized patients with CRKP bacteriuria, 53 had genes that encoded carbapenemase: KPC-2 (n = 43), KPC-17 (n = 7), VIM-1 (n = 1), IMP-8 (n = 1) and OXA-48 (n = 1). The 14-day and 28-day mortality were 12.7% and 23.0%, respectively. Critically ill patients (n = 53, 42.1%) had significantly higher mortality to non-critically ill patients. Appropriate antimicrobial therapy was used in 33 patients (26.2%). In the multivariate Cox analysis, APACHI II score was the only independent risk factor for 14-day mortality (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.08–1.22; P < 0.001). APACHI II score (HR, 1.11; 95% CI, 1.06–1.16; P < 0.001) and immunocompomised state (HR, 3.27; 95% CI, 1.21–8.81; P = 0.019) were the independent risk factors for 28-day mortality. We further stratified patients into critically ill and non-critically ill group, and found appropriate antimicrobial therapy was not associated with survival benefit in both groups. Conclusion: Host factors were the predictors for mortality in patients with CRKP bacteriuria. Antimicrobial treatment was not associated with survival benefit in either critically ill or non-critically ill patients. The findings may provide some insight on future antibiotic stewardship interventions.
Date:	2017-11
Relation:	International Journal of Antimicrobial Agents. 2017 Nov;50(Suppl. 2):S242.
Link to:	http://dx.doi.org/10.1016/S0924-8579(17)30423-5
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0924-8579&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:000416028900612
Appears in Collections:	[Leung-Kei Siu] Conference Papers/Meeting Abstract

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