Klebsiella pneumoniae Pneumonia in the Medical Intensive Care Units: Epidemiology and Effectiveness of Different Antibiotic Strategies

• Main Authors: Yu-Ju Chen, 陳俞如
• Other Authors: Ying-Chi Lin
• Format: Others
• Language: en_US
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/6n669y

碩士 === 高雄醫學大學 === 藥學系臨床藥學碩士班 === 106 === Background K. pneumoniae is one of the most common pathogens in medical ICUs, and the high mortality rate poses a threat to the medical care professionals and patients. According to the report of the Taiwan Nosocomial Infections Surveillance System in 2017, K. pneumoniae is the most frequently isolated pathogen in pneumonic patients of ICUs in the medical centers. Therefore, our study has two aims: The first, to find the risk factors of mortality related to K. pneumoniae pneumonia of ICU patients. The second, find a better antibiotic regimen for patients infected with K. pneumoniae pneumonia who admitted to medical ICU. Methods This is a retrospective observational study conducted in medical intensive care units (MICU) of three hospitals affiliated to Kaohsiung Medical University. Patients with K. pneumoniae pneumonia admitted to MICU during January 2009 to December 2015 who met the inclusion criteria would be selected from the Research Database of KMU. Their clinical data would be collected from their electronic medical records. The primary clinical outcome in our study was ICU mortality. To access the risk factors for ICU mortality and the effectiveness of different antibiotic strategies, adjusted odds ratios (aORs) and 95% confidence interval (CIs) were acquired by multivariate analysis with logistic regression model. Results 416 patients matched the inclusion and exclusion criteria and the mortality was 37.3%. In the multivariate logistic regression model, pneumonia complicated with bacteremia (aOR, 4.30; 95% CI, 2.17-8.50; P < .0001), prior use of immunosuppression agent (aOR, 3.67; 95% CI, 1.32-10.20; P =0.0126), and APACHE II score, (aOR, 1.05; 95% CI, 1.02-1.08; P =0.0007), Glasgow coma scale (aOR, 0.88; 95% CI, 0.82-0.95; P = 0.0004), platelet count (aOR, 0.997; 95% CI, 0.995-0.999; P = 0.0027), were significantly associated with ICU mortality. As for antibiotic analysis, tigecycline-based definitive therapy was significantly associated with higher ICU mortality (aOR, 5.01; 95％CI,1.05-23.84; P =0.0427). There was no difference in the effectiveness of penicillin-based and 3rd or 4th cephalosporin-based antibiotics. Conclusion Pneumonia was the most common infection site in our populations and pneumonia complicated with bacteremia and prior use of immunosuppression agent would significantly increase the mortality. As for antibiotic analysis, tigecycline-based definitive therapy was associated with the worst outcome. In the future, more studies are needed to confirm the effectiveness of antibiotic therapies in pneumonia caused by K. pneumoniae.