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.
D. H. Lee, None
T. Bias, None
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