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Treatment of KPC-producing Enterobacteriaceae: suboptimal efficacy of polymyxins

M S de Oliveira1, D B de Assis1, M P Freire2

  • 1Department of Infection Control of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|January 21, 2015
PubMed

Insights

Treating Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae infections (KPC-EI) is difficult. This study found polymyxins had suboptimal efficacy, and combination therapy was not better than monotherapy for KPC-EI outcomes.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Pharmacology

Background:

  • Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC-EI) infections present significant therapeutic challenges.
  • Optimal antimicrobial strategies for KPC-EI remain unclear, with combined therapies often proposed but lacking comparative data.

Purpose of the Study:

  • To evaluate the effectiveness of different antimicrobial regimens for treating KPC-EI.
  • To identify prognostic factors associated with mortality in patients with KPC-EI.

Main Methods:

  • Retrospective cohort study of 118 patients with KPC-EI nosocomial infections across three Brazilian tertiary hospitals (October 2009 - June 2013).
  • Primary outcomes included 30-day mortality for all infections and for patients with bacteremia.
  • Multivariate analysis assessed risk factors for mortality, comparing clinical variables between survivors and non-survivors.

Main Results:

  • Catheter-related bloodstream infections were most common (43%), followed by urinary tract infections (23%).
  • Polymyxin plus carbapenem was the most frequent combination therapy (33%).
  • Multivariate analysis identified renal failure, polymyxin use, and older age as significant prognostic factors for mortality.

Conclusions:

  • Polymyxins demonstrated suboptimal efficacy in treating KPC-EI.
  • Combination antimicrobial therapy was not found to be superior to monotherapy for KPC-EI.
Keywords:
Carbapenem resistanceKPCmortalitytreatment

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