There has been an increased incidence of carbapenem-resistant Klebsiella pneumoniae (CRKP). In vitro data and case reports suggest a benefit of ertapenem-containing double-carbapenem therapy (ECDCT) for the treatment of CRKP infections, though limited in vivo data exists to support this regimen. Our objective was to describe clinical and microbiologic cure rates and mortality in patients with infections due to CRKP who received ECDCT.
This was a retrospective case series of inpatients at Temple University Hospital. Included patients received ECDCT for ≥ 48 hours for the treatment of infections due to CRKP according to the Centers for Disease Control and Prevention definition of health-care associated infection and criteria for specific types of infection in the acute setting. Data collected at baseline included gender, age, APACHE score, and Charlson Comorbidity Index (CI). The primary outcomes of the study were microbiologic and clinical cure. Secondary outcomes were 30-day mortality, relapse of infection within 90 days, and development of new onset renal dysfunction and seizures.
20 patients were included; the most common site of infection was the bloodstream (35%), followed by the lungs (35%), urine (15%), and skin and skin structure infections (SSSI) (15%). The patient population was 50% male, median age was 61 (interquartile range (IQR) 50 to 67), median APACHE score of 21 (IQR 14 to 26), and median CI of 3 (IQR 2 to 4). Microbiologic cure was observed in 11/14 (79%) evaluable patients: bacteremia 7/7 (100%), pneumonia 1/4 (25%), and UTI 3/3 (100%). Clinical cure was observed in 13/20 (65%) patients: bacteremia 5/7 (71%), pneumonia 2/7 (29%), UTI 3/3 (100%), and SSSI 3/3 (100%). Mortality was observed in 6/20 patients (30%): bacteremia 1/7 (14%) and pneumonia 5/7 (80%). Relapse was documented for 2 patients treated for bacteremia, 1 patient treated for a SSSI, and 1 patient treated for a UTI. New onset renal dysfunction was observed in 3/16 (19%) evaluable patients and 2/20 (10%) patients developed seizures during ECDCT, one of which was a new onset seizure.
Our data suggest ECDCT may be effective for the treatment of infections due to CRKP with limited treatment options, particularly UTIs.
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