Does Antimicrobial Therapy Affect Mortality of Patients with Carbapenem-Resistant Klebsiella pneumoniae Bacteriuria? A Nationwide Multicenter Study in Taiwan.
Chien ChuangChin-Fang SuJung-Chung LinPo-Liang LuChing-Tai HuangJann-Tay WangYin-Ching ChuangL Kristopher SiuChang-Phone FungYi-Tsung LinPublished in: Microorganisms (2020)
Few clinical studies have previously discussed patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteriuria. This study aimed to assess the effect of antimicrobial therapy on the mortality of patients with CRKP bacteriuria. Hospitalized adults with CRKP bacteriuria were enrolled retrospectively from 16 hospitals in Taiwan during 2013 and 2014. Critically ill patients were defined as those with an Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥ 20. Multivariate Cox regression analysis was used to determine independent risk factors for 14- and 28-day mortality. Of 107 patients with CRKP bacteriuria, the 14-day and 28-day mortality was 14.0% and 25.2%, respectively. Thirty-three patients received appropriate antimicrobial therapy. In the multivariate Cox regression analysis, the APACHE II score ≥ 20 was the only independent risk factor for 14-day mortality (hazard ratio [HR]: 6.15, p = 0.024). APACHE II score ≥ 20 (HR: 3.05, p = 0.018) and male sex (HR: 2.57, p = 0.037) were associated with 28-day mortality. Among critically ill patients with CRKP bacteriuria, appropriate antimicrobial therapy was not associated with 14-day or 28-day survival. In conclusion, in patients with CRKP bacteriuria, the use of appropriate antimicrobial therapy was not an independent factor associated with reduced mortality. Our findings may inform future antibiotic stewardship interventions for bacteriuria caused by multidrug resistant pathogens.
Keyphrases
- klebsiella pneumoniae
- multidrug resistant
- cardiovascular events
- urinary tract infection
- staphylococcus aureus
- risk factors
- escherichia coli
- end stage renal disease
- cardiovascular disease
- chronic kidney disease
- public health
- type diabetes
- physical activity
- stem cells
- mental health
- coronary artery disease
- cystic fibrosis
- acinetobacter baumannii
- peritoneal dialysis
- prognostic factors
- current status
- patient reported outcomes
- antimicrobial resistance
- respiratory failure