{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T03:04:16Z","timestamp":1789787056214,"version":"4.0.1"},"reference-count":31,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2017,8,1]],"date-time":"2017-08-01T00:00:00Z","timestamp":1501545600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Combination therapy including colistin and a carbapenem has been found to be associated with lower mortality in the treatment of bloodstream infections (BSI) due to KPC-producing\n            <jats:named-content content-type=\"genus-species\">Klebsiella pneumoniae<\/jats:named-content>\n            when the isolates show a meropenem or imipenem MIC of &lt;16 mg\/liter. However, the optimal treatment of BSI caused by colistin- and high-level carbapenem-resistant KPC-producing\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            is unknown. A prospective cohort study including episodes of bacteremia caused by colistin-resistant and high-level meropenem-resistant (MIC \u2265 64 mg\/liter) KPC-producing\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            diagnosed from July 2012 to February 2016 was performed. The impact of combination therapy on crude 30-day mortality was analyzed by Cox regression using a propensity score as a covariate to control for indication bias and in an inverse probability of treatment weighting (IPTW) cohort. The study sample comprised 104 patients, of which 32 (30.8%) received targeted monotherapy and 72 (69.2%) received targeted combination therapy; none of them received either colistin or a carbapenem. The 30-day crude mortality rate was 30.8% (43.8% in patients treated with monotherapy and 25% in patients receiving combination therapy). In the Cox regression analysis, 30-day mortality was independently associated with septic shock at BSI onset (hazard ratio [HR], 6.03; 95% confidence interval [CI], 1.65 to 21.9;\n            <jats:italic>P<\/jats:italic>\n            = 0.006) and admission to the critical care unit (HR, 2.87; 95% CI, 0.99 to 8.27;\n            <jats:italic>P<\/jats:italic>\n            = 0.05). Targeted combination therapy was associated with lower mortality only in patients with septic shock (HR, 0.14; 95% CI, 0.03 to 0.67;\n            <jats:italic>P<\/jats:italic>\n            = 0.01). These results were confirmed in the Cox regression analysis of the IPTW cohort. Combination therapy is associated with reduced mortality in patients with bacteremia due to colistin-resistant KPC-producing\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            with high-level carbapenem resistance in patients with septic shock.\n          <\/jats:p>","DOI":"10.1128\/aac.00406-17","type":"journal-article","created":{"date-parts":[[2017,5,31]],"date-time":"2017-05-31T00:40:34Z","timestamp":1496191234000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":65,"title":["Mortality Associated with Bacteremia Due to Colistin-Resistant Klebsiella pneumoniae with High-Level Meropenem Resistance: Importance of Combination Therapy without Colistin and Carbapenems"],"prefix":"10.1128","volume":"61","author":[{"given":"Isabel","family":"Machuca","sequence":"first","affiliation":[{"name":"Infectious Diseases Unit, Hospital Universitario Reina 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