Purpose: The impact of antimicrobial treatment on the outcome of carbapenem non-susceptible K. pneumoniae (CnsKP) infections needs to be elucidated. This nationwide, multicenter study was conducted to evaluate the impact of appropriate antimicrobial therapy on 14-day mortality among patients with CnsKP infection in Taiwan. Particular attention was focused on the outcome related to different levels of disease severity. Methods: Patients with CnsKP infections from 11 medical centers and four regional hospitals in Taiwan were enrolled in 2013. Carbapenem non-susceptibility was defined as a minimum inhibitory concentration of ≥2 mg/L for imipenem or meropenem. Predictors of 14-day mortality were determined using the Cox proportional regression model. The influence of infection severity on the impact of appropriate use of antimicrobials on 14-day mortality was determined using the Acute Physiology and Chronic Health Evaluation (APACHE) II score. Results: Overall 14-day mortality was 31.8% (49/154 patients). Unadjusted mortality for appropriate antimicrobial therapy was 23.1% (18/78 patients). Appropriate therapy was independently associated with reduced mortality (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.24 to 0.80; P = 0.007). A subgroup analysis revealed that the benefit of appropriate therapy was limited to patients with higher APACHE II scores (HR for patients with scores >15 and ≤35, 0.46 [95% CI, 0.23 – 0.92]; HR for those with scores >35, 0.14; 95% CI, 0.02 – 0.99). Conclusions: In conclusion, appropriate antimicrobial therapy significantly reduces 14-day mortality for CnsKP infections. Survival benefit is more notable among more severely ill patients.
Date:
2015-04
Relation:
Journal of Microbiology, Immunology and Infection. 2015 Apr;48(2, Suppl. 1):S40.
