Evidence map›Paper›PMID 24514083›Full record

ArticleAntimicrobial agents and chemotherapy2014

Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems.

George L Daikos, Sophia Tsaousi, Leonidas S Tzouvelekis, Ioannis Anyfantis, Mina Psichogiou, Athina Argyropoulou, Ioanna Stefanou, Vana Sypsa, Vivi Miriagou, Martha Nepka and 4 more

4 registry-linked trialsOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Antimicrobial agents and chemotherapy, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 265 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
265citing papers in PubMed, 9 pooled it
25.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02709408 completednot on this mapstarted 2016, after this paper: background citation

Prospective Observational Study to Assess the Risk Factors, Clinical Management and Outcomes of Hospitalized Patients With Serious Infections Caused by Carbapenem-resistant Enterobacteriaceae and Acinetobacter Baumannii

Typeobservational_patient_registrySponsorFundación Pública Andaluza para la gestión de la Investigación en SevillaRan2016 to 2018Enrolled2,515ConditionsCarbapenem Resistant Bacteria Infection
NCT03159078 phase3unknown statusnot on this mapstarted 2017, after this paper: background citation

Polymyxin B Monotherapy Versus Polymyxin B-Carbapenem Combination Therapy in Critically Ill Patients With Multi-drug Resistant Gram-negative Infection: A Prospective, Parallel-Group, Double-Blind, Randomized Controlled Study

TypeinterventionalSponsorUniversity of Puerto RicoRan2017 to 2019Enrolled40ConditionsTrauma, Resistant Infection, Critical IllnessArmsPolymyxin B
NCT03597841 completednot on this mapstarted 2018, after this paper: background citation

Turkish Prospective Cohort Study on Carbapenem Resistant Klebsiella Pneumonia Bacteremia: a National Multicenter Observational Study

TypeobservationalSponsorKoç UniversityRan2018 to 2019Enrolled278ConditionsKlebsiella Pneumonia, BacteremiaArmsCombination therapy
NCT04202861 naunknown statusnot on this mapstarted 2019, after this paper: background citation

A Randomised Controlled Trial Evaluating a Novel Individualised Treatment Strategy for Carbapenem-Resistant Gram-Negative Bacteria Infections (iACT)

TypeinterventionalSponsorSingapore General HospitalRan2019 to 2023Enrolled594ConditionsAntibiotic TherapyArmsIn vitro antibiotic combination testing (iACT)
3 · Its place in the literature

Who cites it

265 citing papers in PubMed, 9 syntheses or guidelines pooled it, 602 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. A meta-analysis for the role of aminoglycosides and tigecyclines in combined regimens against colistin- and carbapenem-resistant Klebsiella pneumoniae bloodstream infections.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2022
    Pooled it
  5. Pooled it
  6. Guideline
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. A review of bloodstream infections-pathogens, pathogenesis, diagnostic strategies, treatment methods-challenges and future aspects.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026
    Review
  11. NDM-ProducingJournal of clinical medicine · 2026
    Article
  12. Article
  13. Article
  14. Coexistence of blaBMC microbiology · 2026
    Article
  15. Article
  16. Article
  17. Article
  18. Review
  19. Article
  20. In vitro synergistic effects of mefloquine combined with other antimicrobial agents on carbapenem-resistant Enterobacterales.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025
    Article

205 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 4 institutions in 2 countries.

George L DaikosFirst Department of Propaedeutic Medicine, University of Athens, Athens, Greece.
Sophia Tsaousi
Leonidas S Tzouvelekis
Ioannis Anyfantis
Mina Psichogiou
Athina Argyropoulou
Ioanna Stefanou
Vana Sypsa
Vivi Miriagou
Martha Nepka
Sarah Georgiadou
Antonis Markogiannakis
Dimitris Goukos
Athanasios Skoutelis
National and Kapodistrian University of Athens · GREvangelismos Hospital · GRLaiko General Hospital of Athens · GRPasteur Hellenic Institute · GR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Carbapenemase-producing Klebsiella pneumoniae strains (CP-Kps) are currently among the most important nosocomial pathogens. An observational study was conducted during 2009 to 2010 in two hospitals located in a high-prevalence area (Athens, Greece). The aims were (i) to evaluate the clinical outcome of patients with CP-Kp bloodstream infections (BSIs), (ii) to identify predictors of mortality, and (iii) to evaluate the various antibiotic schemes employed. A total of 205 patients with CP-Kp BSIs were identified: 163 (79.5%) were infected with KPC or KPC and VIM, and 42 were infected with VIM producers. For definitive treatment, 103 patients received combination therapy (two or more active drugs), 72 received monotherapy (one active drug), and 12 received therapy with no active drug. The remaining 18 patients died within 48 h after the onset of bacteremia. The all-cause 28-day mortality was 40%. A significantly higher mortality rate was observed in patients treated with monotherapy than in those treated with combination therapy (44.4% versus 27.2%; P=0.018). The lowest mortality rate (19.3%) was observed in patients treated with carbapenem-containing combinations. In the Cox proportion hazards model, ultimately fatal disease (hazards ratio [HR], 3.25; 95% confidence interval [CI], 1.51 to 7.03; P=0.003), the presence of rapidly fatal underlying diseases (HR, 4.20; 95% CI, 2.19 to 8.08; P<0.001), and septic shock (HR, 2.15; 95% CI, 1.16 to 3.96; P=0.015) were independent predictors of death. Combination therapy was strongly associated with survival (HR of death for monotherapy versus combination, 2.08; 95% CI, 1.23 to 3.51; P=0.006), mostly due to the effectiveness of the carbapenem-containing regimens.

Indexed as

AdolescentAdultAgedAged, 80 and overAnti-Bacterial AgentsBacterial Proteinsbeta-LactamasesCarbapenemsFemaleHumansKaplan-Meier EstimateKlebsiella InfectionsKlebsiella pneumoniaeMaleMiddle AgedProportional Hazards ModelsAnti-Bacterial AgentsBacterial Proteinsbeta-LactamasescarbapenemaseCarbapenems

Identifiers

PMID24514083
PMCPMC4023796
OpenAlexW2042164350

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.