Karbapenem dirençli Klebsiella pneumonia’nın neden olduğu idrar yolu enfeksiyonları: monoterapi ya da kombineterapi?

Year 2023, , 290 - 297, 05.04.2023

Fatih Temoçin , Şeyma Betül Kayhan , Levent Şensoy , Tuba Kuruoğlu , Aynur Atilla , Esra Tanyel

https://doi.org/10.31362/patd.1244480

Abstract

Amaç: Bu çalışmada karbapenem dirençli Klebsiella pneumoniae'nın neden olduğu sağlık hizmeti ilişkili üriner sistem enfeksiyonlarını değerlendirildi.
Gereç yöntem: Çalışmaya karbapenem dirençli Klebsiella pneumoniae'nın (CR-Kp)neden olduğu sağlık hizmeti ilişkili idrar yolu enfeksiyonu tanısı almış 134 hasta dahil edildi. Hastaların demografik özellikleri, başlangıç klinik durumları, komorbiditeleri ve Charlson komorbidite indeksi kaydedildi. Ayrıca meropenemin CR-Kp izolatları üzerindeki MİK değerleri, tedavi rejimleri, tedaviye klinik ve mikrobiyolojik yanıtları ile hastaların 14 ve 28 günlük mortalite oranları incelendi.
Bulgular: 14 günlük mortalite oranı %34,3, 28 günlük mortalite oranı ise %42,5 bulundu. Ölen hastaların yaş ortalaması anlamlı olarak daha yüksekti (p=0,03). Benzer şekilde ölen hastalarda Charlson komorbidite indeksi (p=0,03) ve qSOFA değerleri (p=0,00) anlamlı olarak yüksekti. Yaşayan hastalarda mikrobiyolojik yanıt oranı daha yüksekti (p=0,01) ve bakteriyemi açısından gruplar arasında fark yoktu (p=0,29). Sepsisli hasta grubunda kombine antibiyoterapinin 14 ve 28 günlük mortalite oranlarını monoterapiye göre anlamlı olarak daha üstün olduğu saptandı (sırasıyla p=0,00 ve p=0,04). Ancak sepsis olmayan hasta gruplarında monoterapi ve kombinasyon tedavisi arasında anlamlı fark yoktu (sırasıyla p=0,72 ve p=0,36).
Sonuç: Çalışmamız, CR-Kp'nin neden olduğu üriner sistem enfeksiyonlarının tedavisinde sepsisli hastalarda kombinasyon tedavisinin, sepsis olmayan hastalarda ise in vitro aktif bir ajanla monoterapinin kullanılabileceğini desteklemektedir.

Keywords

Klebsiella pneumonia, karbapenem dirençli, sağlık hizmetiyle ilişkili enfeksiyon, idrar yolu enfeksiyonu

Supporting Institution

Yok

Urinary tract infections caused by carbapenem-resistant Klebsiella pneumonia: monotherapy or combined therapy?

Abstract

Purpose: In this study, we evaluated healthcare-associated urinary tract infections caused by carbapenem-resistant Klebsiella pneumoniae.
Materials and methods: The study included 134 patients, diagnosed with healthcare-associated urinary tract infection caused by carbapenem-resistant Klebsiella pneumoniae. Demographic features, initial clinical conditions, comorbidities, and Charlson’s comorbidity index of the patients were recorded. In addition, the MIC values of meropenem on the CR-Kp isolates, treatment regimens, clinical and microbiological responses to the treatment, as well as 14- and 28-day mortality rates of the patients, were reviewed.
Results: The 14-day mortality rate was 34.3%, and the 28-day mortality rate was 42.5%. The mean age of the patients who died was significantly higher (p=0.03). Similarly, Charlson’s comorbidity index (p=0.03) and the qSOFA values (p=0.00) were significantly higher in the patients who died. The microbiological response rate was higher in the patients who survived (p=0.01) with no difference in bacteremia between the groups (p=0.29). It was found that combined antibiotherapy provided significantly better 14- and 28-day mortality rates compared to monotherapy in the group of patients with sepsis (p=0.00 and p=0.04, respectively). However, monotherapy and combination therapy in groups of patients without sepsis were insignificant (p=0.72 and p=0.36, respectively).
Conclusion: Our study supports the use of combination therapy in patients with sepsis, and monotherapy with an in-vitro active agent may be used for patients without sepsis in the treatment of urinary tract infections caused by CR-KP.

Keywords

Klebsiella pneumoniae, carbapenem-resistant, healthcare-associated infection;, urinary tract infection

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