Double-carbapenem combination as salvage therapy for untreatable infections by KPC-2-producing Klebsiella pneumoniae

Eur J Clin Microbiol Infect Dis. 2017 Jul;36(7):1305-1315. doi: 10.1007/s10096-017-2936-5. Epub 2017 Feb 16.

Abstract

We report our experience using the double-carbapenem combination as salvage therapy for patients with untreatable infections caused by KPC-2- producing Klebsiella pneumoniae. A total of 27 patients in two institutions in Athens, Greece suffering from complicated urinary tract infections (16) with or without secondary bacteraemia (four and 12 respectively), primary (six) or catheter-related bloodstream infections (two), HAP or VAP (two) and external ventricular drainage infection (one) were treated exclusively with ertapenem and high-dose prolonged infusion meropenem because in-vitro active antimicrobials were unavailable (19) or failed (four) or were contraindicated (six). Most patients presented with severe infections with median APACHE II score of 17 and 11 of those patients (40.7%) had severe sepsis (five) or septic shock (six). The clinical and microbiological success was 77.8 and 74.1% respectively. Crude mortality was 29.6% with attributable mortality of 11.1%. Adverse events, none of them severe, were reported in four patients (14.8%). The double-carbapenem combination as an exclusive regimen represents a safe and valid salvage therapy for untreatable infections by extensively- or pandrug-resistant KPC-producing K.pneumoniae.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Bacteremia / drug therapy
  • Bacteremia / microbiology
  • Carbapenems / administration & dosage*
  • Catheter-Related Infections / drug therapy
  • Catheter-Related Infections / microbiology
  • Female
  • Greece
  • Humans
  • Klebsiella Infections / drug therapy*
  • Klebsiella Infections / microbiology
  • Klebsiella pneumoniae / enzymology*
  • Klebsiella pneumoniae / isolation & purification
  • Male
  • Meropenem
  • Middle Aged
  • Prospective Studies
  • Salvage Therapy / methods*
  • Thienamycins / administration & dosage
  • Treatment Outcome
  • Urinary Tract Infections / complications
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / microbiology
  • Young Adult
  • beta-Lactamases / metabolism*

Substances

  • Anti-Bacterial Agents
  • Carbapenems
  • Thienamycins
  • beta-Lactamases
  • beta-lactamase KPC-2, Klebsiella pneumoniae
  • Meropenem