TABLE 2.
Treatment failure of infections caused by carbapenemase-producing Enterobacteriaceae among different antibiotic treatment regimensa
| First author, yr (reference) | Study design; period, country | Population characteristics; most common underlying diseases | Sites of infection (% of total population) | No. of infected patients who received definitive treatment | Causative pathogen(s) | CLSI yr of susceptibility breakpoints usedb | Antibiotic treatment administered, no. of patients (% treatment failure) |
|
|---|---|---|---|---|---|---|---|---|
| Combination therapy | Monotherapy | |||||||
| Rihani, 2012 (20) | SC retrospective cohort; 2008–2009, USA | 77% were in the ICU at enrollment | Blood, RTI, tissue, wound, drainage, UTI | 22 | Carbapenemase-producing Enterobacteriaceae (K. pneumoniae, E. coli, Enterobacter spp.) | 2010 | Coli-Carba, 4 | Coli, 4 |
| Coli-Tige, 2 | Carba, 3 | |||||||
| Carba-Amk, 2 | Other, 3 | |||||||
| Coli-Rifa, 1 | ||||||||
| Tob-Cfpm, 1 | Total (40) | |||||||
| Tige-Amk-Cfpm, 1 | ||||||||
| Coli-Carba-Tige-Amk, 1 | ||||||||
| Total (17) | ||||||||
| Maltezou, 2009 (14) | SC retrospective cohort; 2007–2008, Greece | 76.2% were ICU patients; DM, COPD, cardiovascular disease | Pneumonia (61.9), SSI (19), bacteremia (9.5), UTI (4.8), peritonitis (4.8) | 19 | KPC-producing K. pneumoniae | 2007 | Coli-Tige, 7 (43) | Gen, 1 (0) |
| Coli-Gen, 3 (0) | ||||||||
| Coli-Tige-Gen, 2 (0) | Unknown | |||||||
| Treatment, 6 (33)c | ||||||||
KPC, Klebsiella pneumoniae carbapenemase; SC, single center; CLSI, Clinical and Laboratory Standards Institute; DM, diabetes mellitus; COPD, chronic obstructive pulmonary disease; UTI, urinary tract infection; RTI, respiratory tract infection; ICU, intensive care unit; SSI, surgical-site infection; Carba, carbapenem; Coli, colistin; Tige, tigecycline; Gen, gentamicin; Amk, amikacin; Azt, aztreonam; Cipro, ciprofloxacin; Lvf, levofloxacin; Cfpm, cefepime; Rifa, rifampin.
The CLSI susceptibility breakpoints used in the included studies are the following: for 2007, Gen ≤ 4, and for 2010, Carba ≤ 4, Gen ≤ 4, Amk ≤ 16, Cipro ≤ 1, Lvf ≤ 2, Azt ≤ 4, Cfpm ≤ 8, and Tob ≤ 4.
In these studies, it was unclear whether the treatment regimens were combination or monotherapy.