1800. Clinical outcomes associated with various treatment options for infections caused by Carbapenem-Resistant Klebsiella pneumoniae (CRKP)
Session: Poster Abstract Session: Resistant Gram-Negative Infections: CRE Epidemiology
Saturday, October 10, 2015
Room: Poster Hall
Background: Given the increasing prevalence and associated mortality, infections caused by Carbapenem-Resistant Klebsiella pneumoniae (CRKP) have been designated an urgent level threat to public health, thereby requiring immediate and aggressive action. Treatment remains a challenge for clinicians as limited antimicrobial options exist with unfavorable side effect profiles. Our study aims to evaluate the effectiveness of various antimicrobial agents on clinical outcomes in patients with CRKP infections. 

Methods: A retrospective, observational study was conducted to evaluate adult patients (age ≥ 18 years) who had a documented CRKP infection between January 2009 and September 2014 and received active antibiotic therapy for ≥ 48 hours. Demographics and disease specific information were collected. Patients were stratified into 2 cohorts: bacteremia and non-bacteremia. Primary outcomes included 30-day and infection-related mortality.  Secondary outcomes included microbiological cure, overall length of stay, and intensive care unit length of stay. Survivors and non-survivors were compared to identify optimal antibiotic regimens.

Results: Ninety-four patients met criteria for inclusion; 24 in the bacteremia group and 70 in the non-bacteremia group. There was a statistically significant increase in infection-related mortality (42% vs. 16%, p=0.008) and 30-day mortality (43% vs. 18%, p=0.023) in the bacteremia and non-bacteremia groups, respectively. In the non-bacteremia group, monotherapy was associated with a significantly lower infection-related mortality rate compared to combination therapy (10% vs. 40%, p=0.039). Moreover, non-survivors received a higher percentage of colistin-based therapy (78% vs. 22%, p=0.003) or carbapenem-based therapy (44% vs. 6%, p=0.008) in comparison to survivors. In the bacteremia group, there were no significant differences in mortality rates based on antibiotic selection.

Conclusion: CRKP infections have a high attributable mortality, especially with concomitant bacteremia. Although no optimal regimen can be elucidated, monotherapy may offer improved outcomes in patients without bacteremia.  Future studies are warranted to confirm these results and provide guidance to direct optimal antibiotic therapy.

Samantha Rosenthal, PharmD1, Aabha Jain, MD2, Dong Heun Lee, MD2 and Tiffany Bias, PharmD, BCPS, AAHIVP1, (1)Pharmacy, Hahnemann University Hospital, Philadelphia, PA, (2)Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA

Disclosures:

S. Rosenthal, None

A. Jain, None

D. H. Lee, None

T. Bias, None

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