2280. Bloodstream Klebsiella pneumonia Infection and Carbapenem Combination Treatment Regimen in High-Dose Vasopressor-Dependent Septic Shock

• Published in: Open forum infectious diseases Vol. 6; no. Supplement_2; p. S781
• Main Authors: Magira, Eleni, Perlikos, Fotis, Kokkoris, Stelios, Zakynthinos, Spyros
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 23.10.2019
• Subjects: Abstracts
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofz360.1958

Abstract Background The clinical effectiveness of the double-carbapenem combination therapy in mechanically ventilated patients with carbapenemase-producing carbapenem-resistant Enterobacteriaceae bloodstream septic shock infection is not well studied. Methods Over a 4-year period (2013–2017), critically ill with high-dose vasopressor-dependent septic shock patients due to infections from Enterobacteriaceae were included in a single-center retrospective study. The clinical presentation of septic shock was defined in accordance with the international guidelines. Clinical characteristics and the presence of clinical success by the 3rd-day of treatment and 28-day outcome were evaluated. Clinical success was defined as the complete elimination of the vasopressors along with the absence of bacteria regrowth in blood cultures of Enterobacteriaceae. The combination therapy consisted of 1-hour ertapenem (1 g/day) infusion followed immediately by meropenem (6 g/day) in a prolonged 3-hour infusion. The therapeutic regimen was also included gentamicin (7 mg/kg) once daily for 3 total days because of the severity of shock. Results A total of 16 ICU patients with bloodstream infection causing septic shock included in the study. The bacterial strain of Enterobacteriaceae was exclusive of Klebsiella pneumonia isolated after the second week of ICU admission. Antibiotic resistance profile was carbapenem 16/16 (100%), colistin 16/16 (100%), tigecycline 14/16 (87%) aminoglycosides 10/16 (62.5%). Patients were comparable in terms of age, comorbidities, APACHE II score, and presence of concomitant ventilator-associated pneumonia. Klebsiella pneumonia bloodstream infection was catheter-related in 5/16 (31%), and the source was not identified in 11/16 (69%). Overall, complete microbiological eradication of Klebsiella pneumonia regrowth in blood cultures performed 72 h after therapy was observed in 14/16 (87%) patients, and complete shock resolution in 12/16 (75%). Death at day 28 occurred in 5/16 (31%) patients attributable to multiple organ failure. Conclusion The double-carbapenem regimen in critically ill patients suffering high-dose vasopressor-dependent septic shock due to bloodstream infections from Klebsiella pneumonia is an effective therapeutic option. Disclosures All authors: No reported disclosures.