Clinical outcomes of patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae after treatment with imipenem or meropenem

doi:10.1016/j.diagmicrobio.2009.02.004

Diagnostic Microbiology and Infectious Disease

Volume 64, Issue 2, June 2009, Pages 233-235

https://doi.org/10.1016/j.diagmicrobio.2009.02.004 Get rights and content

Abstract

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae may appear susceptible to imipenem or meropenem by routine susceptibility testing. We report a series of patients with infections caused by K. pneumoniae isolates, which yielded imipenem-susceptible results but were subsequently KPC-positive by polymerase chain reaction. When these infections were treated with imipenem or meropenem, frequent clinical and microbiologic failures were observed.

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In 2010, the Clinical and Laboratory Standards Institute (CLSI) lowered carbapenem breakpoints to reduce the proportion of ‘susceptible’ organisms that produced carbapenemases. Few studies have evaluated the effect of this change on clinical outcomes. This systematic review aimed to evaluate the effect of carbapenem MICs on 30-day mortality from pooled patient-level data from studies of patients treated with carbapenems across a range of meropenem MICs. PubMed was searched to March 2019 with the terms ‘carbapenem’, ‘meropenem’, ‘imipenem’, ‘doripenem’, ‘ertapenem’, ‘susceptibility’ and ‘outcomes’. Studies were included in the analysis if patients had Enterobacteriaceae bacteraemia treated with a carbapenem for ≥48 h and mortality was reported. Studies were excluded if all isolates were either susceptible or resistant to meropenem based on CLSI 2010 breakpoints or if only carbapenemase-producing isolates were included. Authors were contacted for patient-level data. The primary outcome was 30-day mortality, with planned subset analyses of patients treated with meropenem, receiving active combination therapy, treated in the ICU or infected with Klebsiella pneumoniae. Of 157 articles identified, 4 met the inclusion criteria (115 eligible patients). The odds of mortality increased with each increasing meropenem MIC dilution (OR = 1.51, 95% CI 1.06–2.15) as a continuous variable. A similar increase in odds was observed in patients treated with meropenem, treated in the ICU, infected with K. pneumoniae or receiving no other active antimicrobials. Increasing meropenem MICs in Enterobacteriaceae were associated with increased mortality; however, more work is needed to define optimal clinical decision rules for infections within the susceptible range.
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¹: Authors contributed equally to the work.

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Diagnostic Microbiology and Infectious Disease

Abstract

References (12)

Emergence of serine carbapenemases (KPC and SME) among clinical strains of Enterobacteriaceae isolated in the United States medical centers: report from the MYSTIC program (1999–2005)

Diagn. Microb. Infect. Dis.

Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae

J. Clin. Microbiol.

Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York City

Clin. Infect. Dis.

Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium

Arch. Intern. Med.

Detection of Klebsiella pneumoniae carbapenemase (KPC) by Vitek 2 AST GN Card using ertapenem as the indicator

APACHE II: a severity of disease classification system

Crit. Care Med.

Cited by (98)

Elucidating the antibacterial efficacy of thiadiazol derivative against carbapenem-resistant Klebsiella pneumoniae and Pseudomonas aeruginosa: An in-silico perspective

Assessment of mortality stratified by meropenem minimum inhibitory concentration in patients with Enterobacteriaceae bacteraemia: A patient-level analysis of published data

Mortality, clinical and microbiological response following antibiotic therapy among patients with carbapenem-resistant Klebsiella pneumoniae infections (a meta-analysis dataset)

Carbapenem-resistant Enterobacteriaceae: An emerging bacterial threat

Prevalence and characteristics of ertapenem-mono-resistant isolates among carbapenem-resistant Enterobacterales in China

Hospital-Acquired Infections Caused by Carbapenem-Resistant Enterobacteriaceae: An Observational Study

NotesClinical outcomes of patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae after treatment with imipenem or meropenem

Abstract

Diagn. Microb. Infect. Dis.

Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae

J. Clin. Microbiol.

Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York City

Clin. Infect. Dis.

Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium

Arch. Intern. Med.

Detection of Klebsiella pneumoniae carbapenemase (KPC) by Vitek 2 AST GN Card using ertapenem as the indicator

APACHE II: a severity of disease classification system

Crit. Care Med.

Notes
Clinical outcomes of patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae after treatment with imipenem or meropenem