Urinary tract infections caused by carbapenem-resistant Klebsiella pneumonia: monotherapy or combined therapy?

Abstract

Purpose: In this study, we evaluated healthcare-associated urinary tract infections caused by carbapenem-resistant Klebsiella pneumoniae. 
 Materials and methods: The study included 134 patients, diagnosed with healthcare-associated urinary tract infection caused by carbapenem-resistant Klebsiella pneumoniae. Demographic features, initial clinical conditions, comorbidities, and Charlson’s comorbidity index of the patients were recorded. In addition, the MIC values of meropenem on the CR-Kp isolates, treatment regimens, clinical and microbiological responses to the treatment, as well as 14- and 28-day mortality rates of the patients, were reviewed.
 Results: The 14-day mortality rate was 34.3%, and the 28-day mortality rate was 42.5%. The mean age of the patients who died was significantly higher (p=0.03). Similarly, Charlson’s comorbidity index (p=0.03) and the qSOFA values (p=0.00) were significantly higher in the patients who died. The microbiological response rate was higher in the patients who survived (p=0.01) with no difference in bacteremia between the groups (p=0.29). It was found that combined antibiotherapy provided significantly better 14- and 28-day mortality rates compared to monotherapy in the group of patients with sepsis (p=0.00 and p=0.04, respectively). However, monotherapy and combination therapy in groups of patients without sepsis were insignificant (p=0.72 and p=0.36, respectively)
 Conclusion: Our study supports the use of combination therapy in patients with sepsis, and monotherapy with an in-vitro active agent may be used for patients without sepsis in the treatment of urinary tract infections caused by CR-KP.