Impact of therapy and strain type on outcomes in urinary tract infections caused by carbapenem-resistant <i>Klebsiella pneumoniae</i>

Duin, David van; Cober, Eric; Richter, Sandra; Pérez, Federico; Kalayjian, Robert C.; Salata, Robert A.; Evans, Scott; Fowler, Vance G.; Kaye, Keith S.; Bonomo, Robert A.

doi:10.1093/jac/dku495

Cited by 51 publications

(54 citation statements)

References 25 publications

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“…A case was defined as a physician-diagnosed UTI if the patient received fosfomycin for a presumed or confirmed UTI, as determined by the treating physician (14). A fosfomycin-treated UTI was defined as a physician-diagnosed UTI without negative urine culture results, negative urinalysis results, or receipt of additional antimicrobial agents after the UTI diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Clinical Appraisal of Fosfomycin in the Era of Antimicrobial Resistance

Sastry

Clarke

Alrowais

et al. 2015

Antimicrob Agents Chemother

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Fosfomycin is recommended as one of the first-line agents for treatment of urinary tract infections (UTIs) in the latest guidelines endorsed by the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID). We evaluated the use of fosfomycin among inpatients at a tertiary care hospital between 2009 and 2013. UTI cases were defined using physician diagnosis and the National Healthcare Safety Network (NHSN) surveillance definitions. The number of patients treated with fosfomycin increased from none in 2009 to 391 in 2013. Among 537 patients who received fosfomycin for any indication during this period, UTI was the most common indication (74%), followed by asymptomatic bacteriuria (10%). All except 19 patients received a single dose of fosfomycin. Escherichia coli was the most common organism involved (52%). For 119 patients with UTIs, after exclusion of those with negative urine culture results, negative urinalysis results, receipt of additional agents, or indeterminate clinical outcomes, the clinical success rate at 48 h was 74.8%. Of 89 patients who met the criteria for NHSN-defined UTIs, 89.9% had successful outcomes. Recurrent infections occurred in 4.3% of cases, and mild adverse events were observed in 2.0%. All 100 randomly selected extended-spectrum ␤-lactamase (ESBL)-producing E. coli clinical isolates from this period were susceptible to fosfomycin. In conclusion, the use of fosfomycin has increased substantially since implementation of the updated guidelines at this hospital. Fosfomycin was used mainly for the treatment of physician-diagnosed UTIs, and the clinical outcomes were generally favorable. Fosfomycin maintained activity against E. coli despite the increased use of the agent.

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Section: Methodsmentioning

confidence: 99%

Clinical Appraisal of Fosfomycin in the Era of Antimicrobial Resistance

Sastry

Clarke

Alrowais

et al. 2015

Antimicrob Agents Chemother

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“…For analysis purposes, the type of regimen was assigned as previously reported. 12 Briefly, any regimen which contained an aminoglycoside was deemed “aminoglycoside-based”, then any regimen that contained colistin but not an aminoglycoside was designated “colistin-based”, followed by any regimen that contained tigecycline but not colistin or aminoglycoside, was regarded as “tigecycline-based”. All other regimens were classified as “other”.…”

Section: Methodsmentioning

confidence: 99%

Hospital Readmissions in Patients With Carbapenem-ResistantKlebsiella pneumoniae

Messina

Cober

Richter

et al. 2015

Infect. Control Hosp. Epidemiol.

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Background Various transmission routes contribute to spread of Carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized patients. Patients with readmissions during which CRKP is again isolated (“CRKP readmission”) potentially contribute to transmission of CRKP. Objective Evaluate CRKP readmissions in the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKle). Design Cohort study from 12/24/2011 to 7/1/2013 Setting CRaCKle is a multicenter consortium of acute care hospitals in the Great Lakes region. Patients All patients who were discharged alive during the study period were included. Each patient was included only once at the time of the first CRKP positive culture. Methods All readmissions within 90 days of discharge from the index hospitalization during which CRKP was again found were analyzed. Risk factors for CRKP readmission were evaluated in multivariable models. Results Twenty percent of patients who were discharged alive (56/287) had a CRKP readmission. A history of malignancy was associated with CRKP readmission (aOR 3.00, 95% CI 1.32-6.65, p<0.01). During the index hospitalization, 160 (56%) patients received antibiotic treatment targeted against CRKP. The choice of antibiotic regimen was associated with CRKP readmission (p=0.02). Receipt of tigecycline-based therapy (aOR 5.13, 95% CI 1.72-17.44, using aminoglycoside-based therapy as a reference in those treated with anti-CRKP antibiotics) was associated with CRKP readmission. Conclusion Hospitalized patients with CRKP – specifically those with a history of malignancy – are at high risk of readmission with recurrent CRKP infection or colonization, which may contribute to transmission of CRKP in healthcare systems. Treatment during the index hospitalization with a tigecycline-based regimen increases this risk.

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“…Oral agents that used to be first-line for the treatment of upper UTI (pyelonephritis) and lower UTI (cystitis), such as trimethoprim-sulfamethoxazole and fluoroquinolones, are no longer consistently reliable due to high resistance rates [22]. [2]) and underlying chronic comorbidities (median Charlson score [4]) were common in patients infected and/or colonized with CRE [5] • Hospitalizations during which CRE are isolated tended to be prolonged (median length of stay, 9 days) and included an ICU stay in 51% of patients [5] • Overall mortality = 18% °Associated mortality highest in patients with CRE pneumonia (hospital mortality, 34%; aHR a , 3.44) and bacteremia (hospital mortality, 38%; aHR a , 2.59) °No additional mortality was observed in patients with CRE UTI [5,6] • Readmissions during which CRE were again isolated occurred in 20% of patients within 90 days of discharge [7] • Tigecycline use may lead to sequential tigecycline resistance, and stay in long-term care facilities was found to be a risk factor [8,9] • Common CRKP strain types included ST258A and ST258B [5,10,11] • ST258A was associated with higher treatment failure rates in CRKP bacteriuria [10] • Aminoglycoside was associated with improved outcomes and tigecycline was associated with worse outcomes in patients treated for CRKP bacteriuria [10] Abbreviations: aHR adjusted hazard ratio; CRACKLE, Consortium on Resistance Against Carbapenems in Klebsiella pneumoniae and Other Enterobacteriaceae; CRE, carbapenem-resistant Enterobacteriaceae; CRKP, carbapenem-resistant Klebsiella pneumoniae; ICU, intensive care unit; UTI, urinary tract infection. a CRE urinary colonization was used as the reference group.…”

Section: Oral Step-down Therapy For Urinary Tract Infectionsmentioning

confidence: 99%

Gram-Negative Bacterial Infections: Research Priorities, Accomplishments, and Future Directions of the Antibacterial Resistance Leadership Group

Doi

Bonomo

Hooper

et al. 2017

Clinical Infectious Diseases

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117

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Impact of therapy and strain type on outcomes in urinary tract infections caused by carbapenem-resistant Klebsiella pneumoniae

Abstract: In this nested cohort study of physician-diagnosed CRKP UTI, both choice of treatment and CRKP strain type appeared to impact on clinical outcomes.

Cited by 51 publications

References 25 publications

Clinical Appraisal of Fosfomycin in the Era of Antimicrobial Resistance

Clinical Appraisal of Fosfomycin in the Era of Antimicrobial Resistance

Hospital Readmissions in Patients With Carbapenem-ResistantKlebsiella pneumoniae

Gram-Negative Bacterial Infections: Research Priorities, Accomplishments, and Future Directions of the Antibacterial Resistance Leadership Group

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