Urinary tract infections caused by carbapenem-resistant Klebsiella pneumonia: monotherapy or combined therapy?


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TEMOÇİN F., Kayhan Ş. B., ŞENSOY L., TURAN D. B., ATİLLA A., TANYEL E.

Pamukkale Tıp Dergisi, cilt.16, sa.2, ss.290-297, 2023 (Scopus) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 16 Sayı: 2
  • Basım Tarihi: 2023
  • Doi Numarası: 10.31362/patd.1244480
  • Dergi Adı: Pamukkale Tıp Dergisi
  • Derginin Tarandığı İndeksler: Scopus, Central & Eastern European Academic Source (CEEAS), TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.290-297
  • Ondokuz Mayıs Üniversitesi Adresli: Evet

Özet

Purpose: In this study, we evaluated healthcare-associated urinary tract infections caused by carbapenem-resistant Klebsiella pneumoniae. Materials and methods: The study included 134 patients, diagnosed with healthcare-associated urinary tract infection caused by carbapenem-resistant Klebsiella pneumoniae. Demographic features, initial clinical conditions, comorbidities, and Charlson’s comorbidity index of the patients were recorded. In addition, the MIC values of meropenem on the CR-Kp isolates, treatment regimens, clinical and microbiological responses to the treatment, as well as 14- and 28-day mortality rates of the patients, were reviewed. Results: The 14-day mortality rate was 34.3%, and the 28-day mortality rate was 42.5%. The mean age of the patients who died was significantly higher (p=0.03). Similarly, Charlson’s comorbidity index (p=0.03) and the qSOFA values (p=0.00) were significantly higher in the patients who died. The microbiological response rate was higher in the patients who survived (p=0.01) with no difference in bacteremia between the groups (p=0.29). It was found that combined antibiotherapy provided significantly better 14- and 28-day mortality rates compared to monotherapy in the group of patients with sepsis (p=0.00 and p=0.04, respectively). However, monotherapy and combination therapy in groups of patients without sepsis were insignificant (p=0.72 and p=0.36, respectively). Conclusion: Our study supports the use of combination therapy in patients with sepsis, and monotherapy with an in-vitro active agent may be used for patients without sepsis in the treatment of urinary tract infections caused by CR-KP.