Evaluation of the combination treatments with intravenous fosfomycin for carbapenem-resistant <i>Klebsiella pneumoniae</i>

Önal, Uğur; Tüzemen, Nazmiye Ülkü; Kaya, Pınar Küçükdemirci; İşçimen, Remzi; Girgin, Nermin Kelebek; Özakın, Cüneyt; Kahveci, Ferda Şöhret; Akalın, Halis

doi:10.1590/1806-9282.20230727

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Assoc. Med. Bras. 69 (11) • 2023 • https://doi.org/10.1590/1806-9282.20230727 copy

Evaluation of the combination treatments with intravenous fosfomycin for carbapenem-resistant Klebsiella pneumoniae

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to evaluate the combination treatments with intravenous fosfomycin for carbapenem-resistant Klebsiella pneumoniae infections in a tertiary-care center.

METHODS:

Between December 24, 2018 and November 21, 2022, adult patients diagnosed with bloodstream infection or ventilator-associated pneumonia due to culture-confirmed carbapenem-resistant Klebsiella pneumoniae in the anesthesiology and reanimation intensive care units were investigated retrospectively.

RESULTS:

There were a total of 62 patients fulfilling the study inclusion criteria. No significant difference was recorded in 14- and 30-day mortality among different types of combination regimens such as fosfomycin plus one or two antibiotic combinations. Hypokalemia (OR:5.651, 95%CI 1.019–31.330, p=0.048) was found to be a significant risk factor for 14-day mortality, whereas SOFA score at the time of diagnosis (OR:1.497, 95%CI 1.103–2.032, p=0.010) and CVVHF treatment (OR:6.409, 95%CI 1.395–29.433, p=0.017) were associated with 30-day mortality in multivariate analysis.

CONCLUSION:

In our study, high mortality rates were found in patients with bloodstream infection or ventilator-associated pneumonia due to carbapenem-resistant Klebsiella pneumoniae, and no significant difference was recorded in 14- and 30-day mortality among different types of combination regimens such as fosfomycin plus one or two antibiotic combinations.

KEYWORDS:
Fosfomycin; Bloodstream infection; Ventilator-associated pneumonia; Klebsiella pneumoniae

Variables		14-day mortality		p-value	OR	95%CI	30-day mortality		p-value	OR	95%CI
Variables		Present	Absent	p-value	OR	95%CI	Present	Absent	p-value	OR	95%CI
Age	(years)	53.45±4.17	64.10±2.51	0.029 ^* * p<0.05.	0.966	0.937–0.997	56.74±3.13	64.68±3.15	0.087	–	–
Gender	Male Female	12 10	21 19	0.877	–	–	19 15	14 14	0.644	–	–
Hypertension	Present Absent	6 16	26 14	0.006 ^* * p<0.05.	0.202	0.064–0.632	14 20	18 10	0.073	–	–
Malignancy	Present Absent	11 11	8 32	0.017 ^* * p<0.05.	4.000	1.280–12.502	12 22	7 21	0.383	–	–
Immunosuppression	Present Absent	13 9	7 33	0.001 ^* * p<0.05.	6.810	2.097–22.115	15 19	5 23	0.032 ^* * p<0.05.	3.632	1.115–11.824
Bacteremia	Present Absent	10 12	23 17	0.365	–	–	19 15	14 14	0.644	–	–
CVVHF treatment	Present Absent	10 12	11 29	0.157	–	–	17 17	4 24	0.005 ^* * p<0.05.	6.000	1.712–21.025
APACHE-II score (at the diagnosis of infection)	(point)	25.77±1.59	21.10±1.04	0.021 ^* * p<0.05.	1.105	1.015–1.203	24.53±1.20	20.61±1.31	0.040 ^* * p<0.05.	1.091	1.004–1.185
SOFA score (at the diagnosis of infection)	(point)	10.95±0.81	7.90±0.48	0.004 ^* * p<0.05.	1.303	1.091–1.558	10.68±0.61	6.93±0.48	<0.001 ^* * p<0.05.	1.511	1.200–1.902
Hypernatremia	Present Absent	3 19	14 26	0.081	–	–	10 24	7 21	0.699	–	–
Hypokalemia	Present Absent	9 13	5 35	0.014 ^* * p<0.05.	4.846	1.368–17.171	10 24	4 24	0.164	–	–
Daily fosfomycin dose (adjusted for creatinine clearance)	(g/day)	12.86±0.82	11.86±0.74	0.399	–	–	12.08±0.69	12.37±0.92	0.802	–	–

Variables	14-day mortality			30-day mortality
Variables	p-value	OR	95%CI	p-value	OR	95%CI
Immunosuppression	0.311	–	–	0.075	–	–
SOFA score (1 point increase at the diagnosis of infection)	0.537	–	–	0.010 ^* * p<0.05. Bold values were used for mentioning only the statistically significant results.	1.497	1.103–2.032
APACHE-II score (at the diagnosis of infection)	0.181	–	–	0.985	–	–
CVVHF treatment				0.017 ^* * p<0.05. Bold values were used for mentioning only the statistically significant results.	6.409	1.395–29.433
Age	0.372	–	–
Hypertension	0.083	–	–
Malignancy	0.776	–	–
Hypokalemia	0.048 ^* * p<0.05. Bold values were used for mentioning only the statistically significant results.	5.651	1.019–31.330

Combination type	n (%)	14-day mortality	30-day mortality
Combination with one antibiotic	27 (43%)	6 (22.2%)	11 (40.7%)
Fosfomycin plus meropenem	12 (19%)	3 (25%)	5 (41.6%)
Fosfomycin plus colistin/polymyxin B	7 (11%)	2 (28.5%)	4 (57.1%)
Fosfomycin plus amikacin/gentamycin	3 (5%)	1 (33.3%)	1 (33.3%)
Fosfomycin plus others^* * Others: ceftazidim/avibactam, cefoperazone/sulbactam, tigecycline, TMP/SMX, ciprofloxacin, and levofloxacin.	5 (8%)	0 (0%)	1 (20%)
Combination with two antibiotics	35 (57%)	16 (45.7%)	23 (65.7%)
Fosfomycin plus meropenem plus colistin/polymyxin B	14 (23%)	7 (50%)	10 (71.4%)
Fosfomycin plus meropenem plus amikacin/gentamycin	9 (15%)	3 (33.3%)	4 (44.4%)
Fosfomycin plus colistin/polymyxin B plus amikacin/gentamycin	2 (3%)	0 (0%)	1 (50%)
Fosfomycin plus others^* * Others: ceftazidim/avibactam, cefoperazone/sulbactam, tigecycline, TMP/SMX, ciprofloxacin, and levofloxacin.	10 (16%)	6 (60%)	8 (80%)

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: uguronal@uludag.edu.tr