國家衛生研究院 NHRI:Item 3990099045/11755

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Please use this identifier to cite or link to this item: http://ir.nhri.org.tw/handle/3990099045/11755

Title:	Appropriate treatment for bloodstream infections due to carbapenem-resistant klebsiella pneumoniae and escherichia coli: A nationwide multicenter study in Taiwan
Authors:	Lin, YT;Su, CF;Chuang, C;Lin, JC;Lu, PL;Huang, CT;Wang, JT;Chuang, YC;Siu, LK;Fung, CP
Contributors:	National Institute of Infectious Diseases and Vaccinology
Abstract:	Background: In a multicenter study from Taiwan, we aimed to investigate the outcome of patients who received different antimicrobial therapy in carbapenem-resistant Enterobacteriaceae bloodstream infections and proposed a new definition for tigecycline use. Methods: Patients from 16 hospitals in Taiwan who received appropriate therapy for bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae and Escherichia coli were enrolled in the study between January 2012 and June 2015. We used a cox proportional regression model for multivariate analysis to identify independent risk factors of 14-day mortality. Tigecycline was defined as appropriate when the isolates had a minimum inhibitory concentration (MIC) </=0.5 mg/L, and we investigated whether tigecycline was associated with mortality among patients with monotherapy. Results: Sixty-four cases with carbapenem-resistant K pneumoniae (n = 50) and E coli (n = 14) bloodstream infections were analyzed. Of the 64 isolates, 17 (26.6%) had genes that encoded carbapenemases. The 14-day mortality of these cases was 31.3%. In the multivariate analysis, Charlson Comorbidity Index (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.42; P = .022) and colistin monotherapy (HR, 5.57; 95% CI, 2.13-14.61; P < .001) were independently associated with 14-day mortality. Among the 55 patients with monotherapy, the 14-day mortality was 30.9% (n = 17). Tigecycline use was not associated with mortality in the multivariate analysis. Conclusions: Tigecycline monotherapy was a choice if the strains exhibited MIC </=0.5 mg/L, and colistin monotherapy was not suitable. Our findings can initiate additional clinical studies regarding the efficacy of tigecycline in carbapenem-resistant Enterobacteriaceae infections.
Date:	2019-02
Relation:	Open Forum Infectious Diseases. 2019 Feb;6(2):Article number ofy336.
Link to:	http://dx.doi.org/10.1093/ofid/ofy336
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=2328-8957&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:000461522500001
Cited Times(Scopus):	https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85062180299
Appears in Collections:	[Leung-Kei Siu] Periodical Articles

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