Successful treatment of KPC-3 Klebsiella Pneumoniae ST258 clone with a combination of high-dose tigecycline and colistin in ICU: a case series report.

Abstract

INFECTIONS CAUSED BY KLEBSIELLA PNEUMONIAE SEQUENCE TYPE 258 PRODUCING K. PNEUMONIAE CARBAPENEMASE 3 (KPC-Kp)HAVE WIDELY EMERGED AND BOTH INDIVIDUAL CASES AND OUTBREAKS OF COLONIZATION OR INFECTION HAVE BEEN REPORTED IN PALERMO, ITALY.OBIETTIVO: THIS IS A RETROSPECTIVE CASE SERIES THAT DESCRIBES THE CLINICAL AND MICROBIOLOGIC OUTCOMES OF 16 PATIENTS WHO RECEIVED A COMBINATION OF HIGH-DOSE TIGECYCLINE AND COLISTIN FOR TREATMENT OF VAP (4 CASES) AND SEVERE BACTERAEMIA (12 CASES) DURING THE YEARS 2009-2011. 11 OUT OF THE 16 CASES WERE POST SURGICAL PATIENTS WITH INTRABDOMINAL ABSCESSES DUE TO KPC-Kp. IN 5 CASES COMBINED KPC-Kp AND CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII INFECTION WAS ALSO OBSERVED.RISULTATI: CLINICAL EFFICACY WAS ASSESSED IN ALL 16 PATIENTS, WITH 14 OF THEM HAVING A POSITIVE OUTCOME, DEFINED AS EITHER CLINICAL IMPROVEMENT OR CLINICAL CURE. a CLINICAL SUCCESS APPEARED TO BE MUCH MORE FREQUENT THA THAT PREVIOUSLY REPORTED WITH COLISTIN MONOTHERAPY.CONCLUSIONE: STUDIES EVALUATING COMBINATION THERAPY AND WELL-CONTROLLED CLINICAL TRIALS ARE NEEDED TO DEFINED THE OPTIMAL TREATMENT OF INFECTIOUS CAUSED BY KPC-KpAND, MORE GENERALLLY, CARBAPENEM-RESISTANT BACTERIA.