Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy · 2026
Comparative efficacy of carbapenem and non-carbapenem empirical therapy for Klebsiella pneumoniae Bacteremia.
СтатьяСравнительное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Koutake Yoshimichi, Oishi Hirofumi, Nagasaki Yoji, Yamada Masanori, Fujimoto Airi, Soejima Keiji, Nishi Hiromi, Adaniya Gen, Hayashi Toshinobu
Аннотация
OBJECTIVE: Our previous study suggested that carbapenem therapy may be effective for bacteremia caused by susceptible Klebsiella pneumoniae (non-ESBL-producing and non-carbapenem-resistant isolates), but its comparative efficacy versus non-carbapenem empirical therapy remains unclear. Therefore, in this study, we aimed to compare the efficacy of carbapenem and non-carbapenem empirical therapy for bacteremia caused by susceptible K. pneumoniae.
METHODS: We conducted a multicenter retrospective study in patients (≥18 years) with K. pneumoniae bacteremia between January 2020 and December 2024, classifying them into a carbapenem or non-carbapenem empirical therapy group. Baseline characteristics were adjusted using propensity score matching, and mortality and survival outcomes were compared between the two groups.
RESULTS: Of the 398 included patients, 192 were analyzed after propensity score matching (64 and 128 in the carbapenem and non-carbapenem groups, respectively). The 30-day mortality rate was 14.1% in the carbapenem group and 8.6% in the non-carbapenem group, with no significant between-group difference (P = 0.358). Similarly, no significant difference was observed in 90-day mortality (26.3% vs. 20.7%, P = 0.439). Overall survival did not differ significantly between the groups (P = 0.453).
CONCLUSIONS: For bacteremia caused by susceptible K. pneumoniae, no significant difference in efficacy was detected between carbapenem and non-carbapenem empirical therapy. Although equivalence cannot be confirmed, empirical non-carbapenem therapy is a reasonable option, particularly in patients without risk factors for multidrug-resistant organism involvement, thereby preserving carbapenem use and mitigating the risk of multidrug-resistant organism emergence.
METHODS: We conducted a multicenter retrospective study in patients (≥18 years) with K. pneumoniae bacteremia between January 2020 and December 2024, classifying them into a carbapenem or non-carbapenem empirical therapy group. Baseline characteristics were adjusted using propensity score matching, and mortality and survival outcomes were compared between the two groups.
RESULTS: Of the 398 included patients, 192 were analyzed after propensity score matching (64 and 128 in the carbapenem and non-carbapenem groups, respectively). The 30-day mortality rate was 14.1% in the carbapenem group and 8.6% in the non-carbapenem group, with no significant between-group difference (P = 0.358). Similarly, no significant difference was observed in 90-day mortality (26.3% vs. 20.7%, P = 0.439). Overall survival did not differ significantly between the groups (P = 0.453).
CONCLUSIONS: For bacteremia caused by susceptible K. pneumoniae, no significant difference in efficacy was detected between carbapenem and non-carbapenem empirical therapy. Although equivalence cannot be confirmed, empirical non-carbapenem therapy is a reasonable option, particularly in patients without risk factors for multidrug-resistant organism involvement, thereby preserving carbapenem use and mitigating the risk of multidrug-resistant organism emergence.