Table 2.
Clinical efficacy of different antibiotic regimens on patients with clinical infections due to isolates of carbapenemase-producing Enterobacteriaceae.
| Study periods | Carbapenemase production | Antibiotic regimens | Clinical outcomes | Reference |
|---|---|---|---|---|
| 2005–2009 | 41 patients, with KPC-producing K. pneumoniae bloodstream infections | Carbapenem + colistin, or tigecycline | 28-day mortality rates, 13% for combination group vs. 67% for colistin or tigecycline monotherapy | Qureshi et al., 2012 |
| 2001–2011 (review of MEDLINE database) | Diverse infections, due to isolates of KPC-producing K. pneumoniae | Polymyxin + carbapenem, tigecycline, or aminoglycoside | Treatment failure rates, 25% vs. 49% for combination therapy vs. monotherapy group (73% in polymyxin, and 60% in carbapenem monotherapy group) | Lee and Burgess, 2012 |
| 2010–2011 | 125 patients, with KPC-K. pneumoniae bloodstream infections | Meropenem + tigecycline + colistin (regimen of (triple combination) | Mortality rates, 13% for triple combination therapy vs. 42% monotherapy group | Tumbarello et al., 2012 |
| 2001–2010 | Patients with CPE septicemia, including primarily bacteremia (n = 244), and pneumonia (n = 32), etc. Among CPE isolates, 158 KPC + 140 MβL producers predominantly | Carbapenem + colistin/or aminoglycoside | Mortality rates, 6% vs. > 23% for >2 in vitro active drugs vs. non-susceptible drugs | Tzouvelekis et al., 2012 |
| 2009–2010 | 205 patients, with bloodstream CPE (K. pneumoniae) infections due to 163 KPC + VIM producers, and 42 VIM producers | Two in vitro active drugs | 28-day mortality rates, 27.2% (with MICs of K. pneumoniae to imipenem, meropenem, or doripenem < 8 mg/L) plus a second in vitro active agent vs. 44.4% for monotherapy group | Daikos et al., 2014 |
| 2007–2014 (data were pooled from 20 clinical studies) | 414 patients, with diverse infections due to CPE, mainly harboring KPC or VIM alleles | Heterogeneous regimens, including the carbapenem-containing vs. carbapenem-sparing schemes | Mortality rates, 18.8% for carbapenem-containing therapy group vs. 30.7% for carbapenem-sparing therapy group. | Tzouvelekis et al., 2014 |
KPC, Klebsiella pneumoniae carbapenemase. CPE, carbapenemase-producing Enterobacteriaceae. MβL, metallo-β-lactamase. VIM, Verona integron-encoded metallo-β-lactamases.