TREATMENT AND CLINICAL OUTCOME OF COLISTIN-RESISTANT KLEBSIELLA PNEUMONIAE BACTEREMIA PATIENTS

Dhitiwat Changpradub1, Abhisit Prawang2, Wichai Santimaleeworagun3,4, Sudaluck Thunyaharn5 and Chankit Puttilerpong6*

Abstract

In recent years, emergence of carbapenem-resistant (CRKP) and colistin-resistant Klebsiella pneumoniae (CoRKP) has become one of the leading causes of nosocomial infection worldwide and is a public health concern due to few available treatment options and high mortality. Here, 14-day and in-hospital mortalities of patients infected with CRKP and CoRKP were investigated as well as treatment regimen for salvage therapy and risk factors of in-hospital bacteremia mortality from 1 January 2016 to 31 December 2018. Patients (n = 96) with bacteremia were classified into three groups, namely, those with non-CRKP (n = 58), CRKP (n = 10) and CoRKP (n = 28). The 14-day mortality rate of patients infected with non-CRKP, CRKP and CoRKP was 12, 40 and 61%, respectively and in-hospital mortality 24, 70 and 82%, respectively, with statistically significant difference between non-CRKP and the drug-resistant groups (p-value < 0.05). The treatment regimen associated with a favorable outcome on the 14-day survival rate in bacteremia patients due to CoRKP was gentamicin or amikacin combined with fosfomycin with or without tigecycline. Chronic kidney disease, admission to intensive care unit and Pitt score ?4 were associated with in-hospital mortality among CoRKP patients. In conclusion, patients infected with CoRKP were of the highest mortality. However, the aminoglycosides/fosfomycin combination with or without tigecycline appeared to be a desirable clinical outcome for bacteremia patients due to CoRKP.