Treatment failure of infections caused by carbapenemase-producing Enterobacteriaceae among different antibiotic treatment regimensa

First author, yr (reference)Study design; period, countryPopulation characteristics; most common underlying diseasesSites of infection (% of total population)No. of infected patients who received definitive treatmentCausative pathogen(s)CLSI yr of susceptibility breakpoints usedbAntibiotic treatment administered, no. of patients (% treatment failure)
Combination therapyMonotherapy
Rihani, 2012 (20)SC retrospective cohort; 2008–2009, USA77% were in the ICU at enrollmentBlood, RTI, tissue, wound, drainage, UTI22Carbapenemase-producing Enterobacteriaceae (K. pneumoniae, E. coli, Enterobacter spp.)2010Coli-Carba, 4Coli, 4
Coli-Tige, 2Carba, 3
Carba-Amk, 2Other, 3
Coli-Rifa, 1
Tob-Cfpm, 1Total (40)
Tige-Amk-Cfpm, 1
Coli-Carba-Tige-Amk, 1
Total (17)
Maltezou, 2009 (14)SC retrospective cohort; 2007–2008, Greece76.2% were ICU patients; DM, COPD, cardiovascular diseasePneumonia (61.9), SSI (19), bacteremia (9.5), UTI (4.8), peritonitis (4.8)19KPC-producing K. pneumoniae2007Coli-Tige, 7 (43)Gen, 1 (0)
Coli-Gen, 3 (0)
Coli-Tige-Gen, 2 (0)Unknown
Treatment, 6 (33)c
  • a 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.

  • b 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.

  • c In these studies, it was unclear whether the treatment regimens were combination or monotherapy.