2284. Treatment and Clinical Outcomes Among Infected Patients with Colistin-resistant Klebsiella pneumoniae Bacteremia.

Abstract

BackgroundIn recent years, the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) and colistin-resistant Klebsiella pneumoniae (CoRKP) is one of the leading causes of nosocomial infection worldwide. It has become a public health concern and high mortality, which the few treatment options are available. Salvage treatment caused by CoRKP is still unknown. Here, we explored the 14-day and in hospital mortality to understand the threat to clinical and public health. In addition, we determined the treatment regimen for salvage therapy due to CoRKP bacteremia.MethodsThis was a single-center retrospective cohort study conducted from 2016 to 2018. A total of 96 patients with bacteremia were included; they were classified into three groups according to the infected pathogens with non-carbapenem-resistant Klebsiella pneumoniae (non-CRKP); CRKP and CoRKP. Treatment regimen, 14-day mortality and in hospital mortality were reviewed and compared.ResultsFifty-eight, 10 and 28 patients infected with non-CRKP, CRKP and CoRKP, respectively. The 14-day mortality rate of patients infected with non-CRKP, CRKP and CoRKP was 12.07%, 40% and 60.71%. In hospital mortality was 24.41%, 70% and 82.14%, respectively. All of mortality outcomes had statistically significant different between both of the CoRKP and CRKP group compare to non-CRKP group (P < 0.05). The treatment regimen associated with a favorable outcome on 14-day survival rate in patients with bacteremia due to CoRKP was the antibiotic combination therapy included aminoglycoside (gentamicin or amikacin) with fosfomycin with or without tigecycline. In addition, combination therapy should be avoided prescribing of colistin which supported by lowest survival rate.ConclusionPatients infected with CoRKP bacteremia was the highest 14-day and in hospital mortality. However, the new salvage regimen consisting of aminoglycoside with fosfomycin with or without tigecycline combination was associated with favorable the 14-day survival rate. Disclosures All authors: No reported disclosures.