Appropriate Treatment for Bloodstream Infections Due to Carbapenem-Resistant Klebsiella pneumoniae and Escherichia coli: A Nationwide Multicenter Study in Taiwan

Yi Tsung Lin, Chin Fang Su, Chien Chuang, Jung Chung Lin, Po Liang Lu, Ching Tai Huang, Jann Tay Wang, Yin Ching Chuang, L. Kristopher Siu, Chang Phone Fung

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Background. In a multicenter study from Taiwan, we aimed to investigate the outcome of patients who received different antimicrobial therapy in carbapenem-resistant Enterobacteriaceae bloodstream infections and proposed a new definition for tigecycline use. Methods. Patients from 16 hospitals in Taiwan who received appropriate therapy for bloodstream infections due to carbapenem- resistant Klebsiella pneumoniae and Escherichia coli were enrolled in the study between January 2012 and June 2015. We used a cox proportional regression model for multivariate analysis to identify independent risk factors of 14-day mortality. Tigecycline was defined as appropriate when the isolates had a minimum inhibitory concentration (MIC) ≤0.5 mg/L, and we investigated whether tigecycline was associated with mortality among patients with monotherapy. Results. Sixty-four cases with carbapenem-resistant K pneumoniae (n = 50) and E coli (n = 14) bloodstream infections were analyzed. Of the 64 isolates, 17 (26.6%) had genes that encoded carbapenemases. The 14-day mortality of these cases was 31.3%. In the multivariate analysis, Charlson Comorbidity Index (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.42; P = .022) and colistin monotherapy (HR, 5.57; 95% CI, 2.13-14.61; P < .001) were independently associated with 14-day mortality. Among the 55 patients with monotherapy, the 14-day mortality was 30.9% (n = 17). Tigecycline use was not associated with mortality in the multivariate analysis. Conclusions. Tigecycline monotherapy was a choice if the strains exhibited MIC ≤0.5 mg/L, and colistin monotherapy was not suitable. Our findings can initiate additional clinical studies regarding the efficacy of tigecycline in carbapenem-resistant Enterobacteriaceae infections.

Original languageEnglish
JournalOpen Forum Infectious Diseases
Volume6
Issue number2
DOIs
Publication statusPublished - Feb 1 2019
Externally publishedYes

Keywords

  • antimicrobial therapy
  • bloodstream infection
  • carbapenem
  • Enterobacteriaceae
  • tigecycline

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

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