Characteristics, risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in the intensive care unit

Vardakas, Konstantinos Z.; Matthaiou, Dimitrios K.; Falagas, Matthew E.; Antypa, E.; Koteli, Asimoula; Antoniadou, Eleni

doi:10.1016/j.jinf.2014.11.003

Cited by 68 publications

(68 citation statements)

References 32 publications

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“…Fosfomycin was prescribed for several indications in variable doses and always in combination with other antibiotics. When provided, all-cause mortality ranged from 18.2% to 40.8%, values similar to those reported for combinations of colistin, tigecycline, and aminoglycosides (247)(248)(249)(250). Importantly, 3 of the studies provided data regarding development of resistance during treatment; in 2 studies, resistant bacteria were not isolated, while 1 reported that 3 isolates developed resistance (220,243,246).…”

Section: Non-urinary Tract Infectionssupporting

confidence: 53%

Fosfomycin

et al. 2016

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SUMMARYThe treatment of bacterial infections suffers from two major problems: spread of multidrug-resistant (MDR) or extensively drug-resistant (XDR) pathogens and lack of development of new antibiotics active against such MDR and XDR bacteria. As a result, physicians have turned to older antibiotics, such as polymyxins, tetracyclines, and aminoglycosides. Lately, due to development of resistance to these agents, fosfomycin has gained attention, as it has remained active against both Gram-positive and Gram-negative MDR and XDR bacteria. New data of higher quality have become available, and several issues were clarified further. In this review, we summarize the available fosfomycin data regarding pharmacokinetic and pharmacodynamic properties, thein vitroactivity against susceptible and antibiotic-resistant bacteria, mechanisms of resistance and development of resistance during treatment, synergy and antagonism with other antibiotics, clinical effectiveness, and adverse events. Issues that need to be studied further are also discussed.

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Section: Non-urinary Tract Infectionssupporting

confidence: 53%

Fosfomycin

et al. 2016

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“…In eight studies patients infected with a MDR strain were compared to those with a susceptible one or to those without any infection. Comparative data on the appropriateness of empirical antibiotic treatment were provided by only seven [48,50,51,52,54,55] out of twenty-four studies.…”

Section: General Commentsmentioning

confidence: 99%

Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

Paramythiotou

Routsi

2016

WJCCM

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The incidence of gram-negative multidrug-resistant (MDR) bacterial pathogens is increasing in hospitals and particularly in the intensive care unit (ICU) setting. The clinical consequences of infections caused by MDR pathogens remain controversial. The purpose of this review is to summarize the available data concerning the impact of these infections on mortality in ICU patients. Twenty-four studies, conducted exclusively in ICU patients, were identified through PubMed search over the years 2000-2015. Bloodstream infection was the only infection examined in eight studies, respiratory infections in four and variable infections in others. Comparative data on the appropriateness of empirical antibiotic treatment were provided by only seven studies. In ten studies the presence of antimicrobial resistance was not associated with increased mortality; on the contrary, in other studies a significant impact of antibiotic resistance on mortality was found, though, sometimes, mediated by inappropriate antimicrobial treatment. Therefore, a direct association between infections due to gram-negative MDR bacteria and mortality in ICU patients cannot be confirmed. Sample size, presence of multiple confounders and other methodological issues may influence the results. These data support the need for further studies to elucidate the real impact of infections caused by resistant bacteria in ICU patients.

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“…Enterobacteriaceae are among the most important HAI source (Tumbarello et al 2012). Within enterobacteriaceae family K. pneumoniae is the most common microorganism isolated as a source of infection in HAI (Tumbarello et al 2012; Ben-David et al 2012; Pau et al 2015; Vardakas et al 2015). …”

Section: Introductionmentioning

confidence: 99%

“…Behindhand discovery of novel effective antibiotics relative to increasing bacterial resistance rates pose difficulty in treating infections and increases mortality rates (Chen et al 2012). In studies investigating NKp BSI outcomes crude mortality rate was reported at a high range between 23 and 69% (Kontopidou et al 2014; Tumbarello et al 2012; Ben-David et al 2012; Pau et al 2015; Vardakas et al 2015; van Duin et al 2014; Hoxha et al 2016; Ulu et al 2015; Kang et al 2006; Daikos et al 2014; Correa et al 2013). Structure of nosocomial infections is dynamic and complex and usually includes multiple variables negatively effecting clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection

et al. 2016

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Purpose Klebsiella pneumoniae is the most common endogen agent for nosocomial infections. In this study, mortality markers were investigated in patients with nosocomial K. pneumoniae blood stream infection (NKp BSI).MethodsThe characteristics of patients >16 years who had NKp BSI diagnosis by daily active surveillance between January 2012 and January 2016 were retrospectively evaluated. Patients who died until 28th day of the clinical follow up and those who survived until this time were statistically compared in terms of various risk factors.ResultsOne hundred ninety patients were included into the study. Mortality rate was 47.9%, carbapenem resistance was 43.2%. Statistical analysis have shown that in presence of post-NKp BSI sepsis, septic shock, following in intensive care unit (ICU), meropenem resistance, kidney failure, NKp BSI secondary to pneumonia, use of invasive instruments such as central venous catheter (CVC), urinary catheter (UC) and mechanical ventilator (MV), colostomy, transfusion and hemodialysis mortality was significantly higher. In patients admitted into the hospital for neurological disorders, pancreaticobiliary tract (PBT) diseases and patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and patients in whom NKp BSI secondary to PBT infection mortality rate was lower.ConclusionsSepsis, septic shock, clinical conditions requiring ICU treatment and meropenem resistance increase mortality rates in NKp BSI significantly. Mortality was higher also in patients with NKp BSI secondary to pneumonia, in kidney failure and when invasive instruments were used. On the other hand, in patients who were admitted to the hospital for neurological disorders and PBT diseases mortality rate was lower.

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Characteristics, risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in the intensive care unit

Cited by 68 publications

References 32 publications

Fosfomycin

Fosfomycin

Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection

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