Adverse hospital outcomes associated with the choice of empiric antibiotics in Klebsiella pneumoniae pneumonia: a retrospective observational study.
- Author:
Li Cher LOH
1
;
Mohd Sani Rosdara MASAYUNI
;
Sree RAMAN
;
Tarmizi THAYAPARAN
;
Shalini KUMAR
Author Information
- Publication Type:Journal Article
- MeSH: Anti-Bacterial Agents; pharmacology; therapeutic use; Community-Acquired Infections; Drug Resistance, Bacterial; Hospital Mortality; Hospitals, Teaching; Humans; In Vitro Techniques; Inpatients; Klebsiella Infections; drug therapy; Klebsiella pneumoniae; drug effects; Malaysia; epidemiology; Medical Audit; Outcome Assessment (Health Care); Respiration, Artificial; Retrospective Studies
- From:Annals of the Academy of Medicine, Singapore 2007;36(8):642-646
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTIONIn Malaysia, Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalisation.
PATIENTS AND METHODSWith concern over its rising microbial resistance, we explored the association of empiric antibiotics choices with the hospital outcomes of patients treated for microbial proven K. pneumoniae pneumonia in an urban-based teaching hospital.
RESULTSIn 313 eligible cases reviewed retrospectively, hospital mortality and requirement for ventilation were 14.3% and 10.8% respectively. Empiric regimes that had in vitro resistance to at least one empiric antibiotic (n = 90) were associated with higher hospital mortality (23.3% vs. 10.8%, P = 0.004) with risk increased by about two-fold [Odds ratio (OR), 2.5; 95% confidence interval (CI), 1.3 to 4.8]. Regimes (n = 84) other than the commonly recommended "standard" regimes (a beta-lactam stable antibiotic with or without a acrolide) were associated with higher ventilation rates (16.7% vs. 8.8%, P = 0.047) with similar increased risk [OR, 2.0; 95% CI, 1.0 to 4.3].
CONCLUSIONSOur findings reiterate the clinical relevance of in vitro microbial resistance in adult K. pneumoniae pneumonia and support empiric regimes that contain beta-lactam stable antibiotics.
