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Double-carbapenem combination as salvage therapy for untreatable infections by KPC-2-producing Klebsiella pneumoniae

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Abstract

We report our experience using the double-carbapenem combination as salvage therapy for patients with untreatable infections caused by KPC-2- producing Klebsiella pneumoniae. A total of 27 patients in two institutions in Athens, Greece suffering from complicated urinary tract infections (16) with or without secondary bacteraemia (four and 12 respectively), primary (six) or catheter-related bloodstream infections (two), HAP or VAP (two) and external ventricular drainage infection (one) were treated exclusively with ertapenem and high-dose prolonged infusion meropenem because in-vitro active antimicrobials were unavailable (19) or failed (four) or were contraindicated (six). Most patients presented with severe infections with median APACHE II score of 17 and 11 of those patients (40.7%) had severe sepsis (five) or septic shock (six). The clinical and microbiological success was 77.8 and 74.1% respectively. Crude mortality was 29.6% with attributable mortality of 11.1%. Adverse events, none of them severe, were reported in four patients (14.8%). The double-carbapenem combination as an exclusive regimen represents a safe and valid salvage therapy for untreatable infections by extensively- or pandrug-resistant KPC-producing K.pneumoniae.

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Authors and Affiliations

  1. 4th Department of Internal Medicine, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Chaidari, Greece

    M. Souli

  2. 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece, PO:15123

    I. Karaiskos, L. Galani, E. Barmpouti & H. Giamarellou

  3. 1st Department of Internal Medicine, Konstantopoulio General Hospital, Athens, Greece

    A. Masgala

Authors
  1. M. Souli
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  2. I. Karaiskos
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  3. A. Masgala
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  4. L. Galani
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  5. E. Barmpouti
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  6. H. Giamarellou
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Corresponding author

Correspondence to H. Giamarellou.

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Funding

No funding was received for this study

Conflicts of interest

Maria Souli has received funding for research by Achaogen

Ilias Karaiskos: no conflict of interest to declare

Aikaterini Masgala: no conflict of interest to declare

Lamprini Galani: no conflict of interest to declare

Eleftheria Barmpouti: no conflict of interest to declare

Helen Giamarellou has received funding for research by Pfizer

Ethical approval

The study was approved by the Ethics Review Board of both hospitals.

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Informed consent was obtained from all individual participants or their legal representatives

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Souli, M., Karaiskos, I., Masgala, A. et al. Double-carbapenem combination as salvage therapy for untreatable infections by KPC-2-producing Klebsiella pneumoniae . Eur J Clin Microbiol Infect Dis 36, 1305–1315 (2017). https://doi.org/10.1007/s10096-017-2936-5

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  • DOI: https://doi.org/10.1007/s10096-017-2936-5

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