Methods: A retrospective, observational study was conducted to evaluate adult patients (age ≥ 18 years) who had a documented CRKP blood-stream infection between January 2009 and September 2014. The following clinical outcomes were assessed: 30-day mortality, infection-related mortality, microbiological cure, length of stay, and intensive care unit length of stay.
Results: Twenty-four patients had bacteremia with a median Pitt bacteremia score of 3 (Interquartile range (IQR), 2-5). The most common source of infection was intra-abdominal (14, 58.3%), followed by urine and lung (both 3, 12.5%). Half of patients had a Charlson Comorbidity Index greater than 5, indicating a high baseline probability for overall mortality. Despite primary source control (90.9%), the overall infection related mortality and all-cause 30-day mortality rates were 41.7% and 42.9%, respectively. Colistin and aminoglycoside therapy were associated with suboptimal efficacy and higher infection-related mortality rates, 42% and 50%, respectively. When comparing combination therapy to monotherapy, no significant differences were observed in 30-day or infection-related mortality. Furthermore, source of bacteremia did not significantly impact mortality endpoints. Approximately one in five patients had recurrent infections. Solid organ transplant recipients had a lower rate of 30-day mortality in comparison to non-transplant recipients (0% vs 56.3%, P= 0.045).
Conclusion: CRKP bacteremia was associated with high mortality and recurrence rates. With limited antimicrobial agents, it is a challenge for clinicians to identify optimal treatment. Actions should be taken promptly to (1) recognize CRKP blood-stream infections, (2) select effective antimicrobial treatment options and (3) prevent transmission through infection control measures.
D. H. Lee, None
T. Bias, None