产生碳青霉烯酶的肺炎克雷伯菌(KPCs)的细菌的出现已成为重大的全球公共卫生挑战,而最佳治疗仍不明确。我们使用MEDLINE(2001-2011)对已发表的KPC感染治疗结果的研究和报告进行了系统评价。如果满足以下条件之一,则排除文章或病例:未提供个别患者数据,没有指定治疗方案,没有指定治疗结果,殖民报告,或超过三种抗生素用于治疗KPC感染。提取的数据包括患者人口统计学,感染部位,有机体KPC亚型,针对KPC感染的抗菌治疗,和治疗结果。以探索性方式进行统计分析。共纳入38篇文章,包括105例病例。大多数感染是由于肺炎克雷伯菌(89%)。最常见的感染部位是血液(52%),其次是呼吸(30%),尿液(10%)。49例(47%)接受单一疗法,56例(53%)接受针对KPC感染的联合疗法。与接受联合治疗的病例相比,接受单药治疗的病例明显更多的治疗失败(49%vs25%;p=0.01)。与联合治疗相比,呼吸道感染与单药治疗失败的发生率更高(67%vs29%p=0.03)。与基于多粘菌素的联合治疗相比,多粘菌素单药治疗的失败率更高(73%vs29%;p=0.02);类似地,与基于碳青霉烯的联合治疗相比,碳青霉烯单药治疗的治疗失败率更高(60%vs26%;p=0.03).在三种最常见的抗生素类组合中,总体治疗失败率没有显着差异:多粘菌素加碳青霉烯,多粘菌素联合替加环素,多粘菌素加氨基糖苷(30%,29%,和25%;p=0.6)。总之,联合治疗建议用于治疗KPC感染;然而,在未来的前瞻性临床试验中需要确定哪种抗菌药物组合.
The emergence of Klebsiella pneumoniae carbapenemases (KPCs) producing bacteria has become a significant global public health challenge while the optimal treatment remains undefined. We performed a systematic review of published studies and
reports of treatment outcomes of KPC infections using MEDLINE (2001-2011). Articles or cases were excluded if one of the following was fulfilled: no individual patient data provided, no treatment regimen specified, no treatment outcome specified, report of colonization, or greater than three antibiotics were used to treat the KPC infection. Data extracted included patient demographics, site of infection, organism, KPC subtype, antimicrobial therapy directed at KPC-infection, and treatment outcome. Statistical analysis was performed in an exploratory manner. A total of 38 articles comprising 105 cases were included in the analysis. The majority of infections were due to K. pneumoniae (89%). The most common site of infection was blood (52%), followed by respiratory (30%), and urine (10%). Forty-nine (47%) cases received monotherapy and 56 (53%) cases received combination therapy directed at the KPC-infection. Significantly more treatment failures were seen in cases that received monotherapy compared to cases who received combination therapy (49% vs 25%; p= 0.01). Respiratory infections were associated with higher rates of treatment failure with monotherapy compared to combination therapy (67% vs 29% p= 0.03). Polymyxin monotherapy was associated with higher treatment failure rates compared to polymyxin-based combination therapy (73% vs 29%; p= 0.02); similarly, higher treatment failure rates were seen with carbapenem monotherapy compared to carbapenem-based combination therapy (60% vs 26%; p= 0.03). Overall treatment failure rates were not significantly different in the three most common antibiotic-class combinations: polymyxin plus carbapenem, polymyxin plus tigecycline, polymyxin plus aminoglycoside (30%, 29%, and 25% respectively; p=0.6). In conclusion, combination therapy is recommended for the treatment of KPC infections; however, which combination of antimicrobial agents needs to be established in future prospective clinical trials.