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.