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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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