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. 2012 Jun;34(6):1314-23.
doi: 10.1016/j.clinthera.2012.05.002.

Treatment and clinical outcomes of urinary tract infections caused by KPC-producing Enterobacteriaceae in a retrospective cohort

Bryan T Alexander  1 , Jonas Marschall, Robert J Tibbetts, Elizabeth A Neuner, W Michael Dunne Jr, David J Ritchie
Affiliations

Treatment and clinical outcomes of urinary tract infections caused by KPC-producing Enterobacteriaceae in a retrospective cohort

Bryan T Alexander et al. Clin Ther. 2012 Jun.

Erratum in

  • Clin Ther. 2012 Aug;34(8):1844

Abstract

Background: Optimal treatment regimens for infections caused by Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae are not well-defined.

Objectives: This study describes the treatment and outcomes in patients with urinary tract infection (UTI) caused by KPC-producing Enterobacteriaceae.

Methods: This retrospective cohort study analyzed data from adult inpatients with bacteriuria caused by KPC-positive organisms treated at Barnes-Jewish Hospital from June 1, 2006, to February 1, 2008. KPC-positive isolates were identified utilizing disk-diffusion susceptibility testing and confirmed to contain bla(KPC) via molecular methods.

Results: Twenty-one patients met the inclusion criteria and all were classified as having symptomatic UTI. The majority of patients were female (15/21 [71%]), and the mean (SD) age was 62.4 (15.2) years. Successful clinical and microbiologic responses were observed in 16 patients (76%) for both outcomes. Patients with urinary catheters had them removed or replaced in 9 of 15 cases (60%). Antibiotics active against the isolated pathogen were provided in 14 of 21 cases (67%), often after considerable delay (median, 72.5 hours [range, 4-312 hours]). All 7 patients receiving aminoglycoside therapy had successful clinical and microbiologic responses, and in vitro testing of an extended antibiotic panel revealed high susceptibility rates for tigecycline (28/29 [97%]), minocycline (22/29 [76%]), and fosfomycin (25/29 [86%]) against the KPC-positive isolates.

Conclusions: Although receipt of appropriate therapy was delayed in many cases, clinical outcomes investigated revealed [corrected] high rates of successful response in this defined group of patients Aminoglycosides and tetracycline derivatives suggested therapeutic promise in the treatment of KPC-producing Enterobacteriaceae UTI.

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Conflict of interest statement

Conflict of Interest Statement

The authors indicate that they have no conflicts of interest regarding the content of this article.

Figures

Figure 1
Figure 1
Dendrogram generated from 19 blaKPC-positive K. pneumoniae isolates using RW3A primers from seven patients. All isolates were found to be clonally-related (similarity index > 90%).
See this image and copyright information in PMC

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