Efficacy of Appropriate Antimicrobial Therapy on the Survival of Patients With Carbapenem Nonsusceptible Klebsiella Pneumoniae Infection. Issue 33 (August 2015)

• Record Type: Journal Article
• Authors: Lin, Yi-Tsung; Chuang, Chien; Su, Chin-Fang; Chan, Yu-Jiun; Wang, Lih-Shinn; Huang, Ching-Tai; Chuang, Yin-Ching; Siu, L. Kristopher; Fung, Chang-Phone; Mahmood S, Choudhery.
• Is Part Of: Medicine. Volume 94:Issue 33(2015)
• Publication Date: 2015-08
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000001405
• Languages: English
• ISSNs: 0025-7974

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Abstract</title> <p>The impact of antimicrobial treatment on the outcome of carbapenem nonsusceptible <italic>Klebsiella pneumoniae</italic> (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.</p> <p>Patients with CnsKP infections from 11 medical centers and 4 regional hospitals in Taiwan were enrolled in 2013. Carbapenem nonsusceptibility 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.</p> <p>Overall 14-day mortality was 31.8% (49/154). 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], 0.24–0.80; <italic>P</italic> = 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; and for those with scores >35, 0.14; 95% CI, 0.02–0.99).</p> <p>In conclusion, appropriate antimicrobial therapy significantly reduces 14-day mortality for CnsKP infections. Survival benefit is more notable among more severely ill patients.</p> </sec> </abstract>