Double carbapenem therapy for carbapenem-resistant Klebsiella pneumoniae bacteraemia

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Önal U. , Akyol D., Uyan A., Bulut C., Guliyeva G., Yamazhan T., ...More

ECCMID 2018, Madrid, Spain, 21 - 24 April 2018, pp.646-647

  • Publication Type: Conference Paper / Summary Text
  • City: Madrid
  • Country: Spain
  • Page Numbers: pp.646-647


Background: In this study our aim was to describe the outcomes of patients with blood stream infections with carbapenem resistant Klebsiella pneumoniae (CRKP) who received ertapenem containing double carbapenem therapy (ECDCT) retrospectively. Materials/methods: This study was performed at a tertiary-care educational university hospital. Adult (>18 years old) patients with culture proven CRKP bacteremia treated with double carbapenem regimen between Aug 2016 to Oct 2017 were included in the study. Blood cultures were performed on Bact-Alert (Bio Merioux, France). Antimicrobial susceptibility testing of the isolates was performed with the VITEK 2 system (bioMérieux). Resistance to imipenem, ertapenem, and meropenem was tested by E-test (bioMérieux). The results were interpreted according to the EUCAST criteria. Ertapenem dosage was adjusted as creatinine clerance as >30 1 gr/day (7 cases); <30 0.5gr/day (5 cases) while meropenem dosage was 3x1 gr/day when creatinine clerance >50 (5 cases), 2x1gr/day when 10-50 (5 cases) and 2x500mg/day <10 (1 case). Results: There were a total of 11 cases fulfilling study criteria. Male/female ratio was 9/2 (mean age 54.18+/-18.40 years). Nine cases had concomitant CRKP urinary tract infections and history of urological operation. Seven cases had a history of antibiotic usage in the previous one month period. All of the isolates were resistant to meropenem and ertapenem with the MIC levels ≥ 16 and ≥8 μg/ml, respectively. Five isolates were resistant to colistin and nine isolates were also resistant to gentamycin. Five isolates were found to be sensitive (MIC ≤ 2 μg/ml) and one isolate was intermediately sensitive (MIC=4 μg/ml) to tigecycline. All of the cases were treated with ECDCT. In 6 cases ECDCT was combined with colistin and combined with tigecycline in 4. Mean duration of ECDCT was 15.5 +/- 4.5 days. Microbiologic eradication was observed in all cases within a mean of 6 days. Overall one-month survival rates (with one relapse and one reinfection (with Enterococci)) were 90.9% (10/11) and one case died due to hepatic encephalopaty and multiple organ failure while waiting for liver transplantation. Conclusions: Although the number of cases is low and uncontrolled, ECDCT containing therapy resulted in relatively high successful outcome in CRKP bacteremia.