Retrospective evaluation of the patients with urinary tract infections due to carbapenemase producing Enterobacteriaceae


Onal U., Sipahil O. R., Pullukcul H., YAMAZHAN T., ARDA B., ULUSOY S., ...More

JOURNAL OF CHEMOTHERAPY, vol.32, no.1, pp.15-20, 2020 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 32 Issue: 1
  • Publication Date: 2020
  • Doi Number: 10.1080/1120009x.2019.1688490
  • Journal Name: JOURNAL OF CHEMOTHERAPY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, PASCAL, Agricultural & Environmental Science Database, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.15-20
  • Keywords: Urinary tract infection, carbapenem resistance, Klebsiella pneumoniae, treatment, risk factors, prognosis, KLEBSIELLA-PNEUMONIAE, RESISTANT ENTEROBACTERIACEAE, MOLECULAR CHARACTERIZATION, EPIDEMIOLOGY, SPREAD, OXA-48
  • Bursa Uludag University Affiliated: No

Abstract

In this study, we aimed to investigate retrospectively the patients with carbapenem-resistant Enterobacteriaceae urinary tract infections (UTIs) in the terms of demographic findings, antibiotic sensitivity patterns and clinical features along with the treatment options. This study was performed at a tertiary-care educational university hospital. Adult (>18 years old) patients diagnosed with culture proven UTI due to carbapenem-resistant Klebsiella pneumoniae (between December 2016 to December 2017) were included in the study. Antimicrobial susceptibility testing of the isolates was performed with the VITEK 2 system (bioMerieux). Resistance to imipenem, ertapenem, and meropenem was tested by E-test (bioMerieux). The results were interpreted according to the EUCAST criteria. A total number of 100 patients (34% female, mean age 61.69 +/- 1.65 years) were included in this study. One month all-cause mortality rate was 19%. Microbiologic eradication rate was 88.7% while it was significantly higher in combination therapy (65/70 vs. 14/19, p = 0.019) and carbapenem long-lasting (4 h) infusion subgroups (54/56 vs. 2/56, p = 0.005). Relapse and reinfection rates were 61.7 and 29.7%, respectively. Logistic regression analysis for mortality risk factors resulted as history of ertapenem usage (OR: 4.74, 95% CI: 0.678-33.201, p = 0.117), lack of microbiologic eradication (OR: 21.7, 95% CI: 1.906-247.375, p = 0.013) and ICU stay (OR: 54.8, 95% CI: 4.145-726.324, p = 0.002). Combination, carbapenem long-lasting infusion and double carbapenem therapies seem to result in higher microbiologic eradication rates and thus may effect the mortality rates of these group of patients. Randomized-controlled studies should be performed in this critical patient group to confirm these results.