Journal Article

Treatment of Klebsiella Pneumoniae Carbapenemase (KPC) infections: a review of published case series and case reports

Lee, Grace C, Burgess, David S

2012

Overview

The emergence of Klebsiella pneumoniae carbapenemases (KPCs) producing bacteria has become a significant global public health challenge while the optimal treatment remains undefined. We performed a systematic review of published studies and reports of treatment outcomes of KPC infections using MEDLINE (2001–2011). Articles or cases were excluded if one of the following was fulfilled: no individual patient data provided, no treatment regimen specified, no treatment outcome specified, report of colonization, or greater than three antibiotics were used to treat the KPC infection. Data extracted included patient demographics, site of infection, organism, KPC subtype, antimicrobial therapy directed at KPC-infection, and treatment outcome. Statistical analysis was performed in an exploratory manner. A total of 38 articles comprising 105 cases were included in the analysis. The majority of infections were due to K. pneumoniae (89%). The most common site of infection was blood (52%), followed by respiratory (30%), and urine (10%). Forty-nine (47%) cases received monotherapy and 56 (53%) cases received combination therapy directed at the KPC-infection. Significantly more treatment failures were seen in cases that received monotherapy compared to cases who received combination therapy (49% vs 25%; p= 0.01). Respiratory infections were associated with higher rates of treatment failure with monotherapy compared to combination therapy (67% vs 29% p = 0.03). Polymyxin monotherapy was associated with higher treatment failure rates compared to polymyxin-based combination therapy (73% vs 29%; p = 0.02 ) ; similarly, higher treatment failure rates were seen with carbapenem monotherapy compared to carbapenem-based combination therapy (60% vs 26%; p = 0.03). Overall treatment failure rates were not significantly different in the three most common antibiotic-class combinations: polymyxin plus carbapenem, polymyxin plus tigecycline, polymyxin plus aminoglycoside (30%, 29%, and 25% respectively; p=0.6). In conclusion, combination therapy is recommended for the treatment of KPC infections; however, which combination of antimicrobial agents needs to be established in future prospective clinical trials.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Aminoglycoside antibiotics / Aminoglycosides / Aminoglycosides - therapeutic use / Analysis / Anti-Bacterial Agents - therapeutic use / Antibiotics / Antimicrobial agents / Bacteremia - drug therapy / Bacteremia - microbiology / Bacteria / Bacterial pneumonia / Bacterial Proteins - metabolism / Beta lactamases / beta-Lactamases - metabolism / Bibliographic literature / Biochemistry / Biomedical and Life Sciences / Biomedicine / Blood / Carbapenemase / Carbapenems / Carbapenems - therapeutic use / Care and treatment / Case reports / Case studies / Clinical trials / Colonization / Data processing / Demography / Drug Combinations / Drug Resistance / Drug therapy / Drug therapy, Combination / Failure / Female / Health aspects / Humans / Infection / Infections / Infectious Diseases / Intensive care / Klebsiella / Klebsiella infections / Klebsiella Infections - drug therapy / Klebsiella Infections - microbiology / Klebsiella pneumoniae / Klebsiella pneumoniae - drug effects / Klebsiella pneumoniae - growth & development / Klebsiella pneumoniae carbapenemases / KPC / Male / Medical Microbiology / Microbial Genetics and Genomics / Microbial Sensitivity Tests / Middle Aged / Minocycline - analogs & derivatives / Minocycline - therapeutic use / Mortality / Parasitology / Patient outcomes / Patients / Pharmacy / Pneumonia / Polymyxin / Polymyxins / Polymyxins - therapeutic use / Public health / Review / Statistical analysis / Studies / Success / Tigecycline / Treatment Outcome / Urine