Antimicrobial resistance and risk factors for mortality of pneumonia caused by Klebsiella pneumoniae among diabetics: a retrospective study conducted in Shanghai, China

• Published in: Infection and drug resistance Vol. 12; pp. 1089 - 1098
• Main Authors: Liu, Bing, Yi, Huahua, Fang, Jie, Han, Lizhong, Zhou, Min, Guo, Yi
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.05.2019; Dove; Dove Medical Press
• Subjects: Albumin; Amikacin; Antibacterial agents; antimicrobial resistance; Aztreonam; Cefotetan; China; Comparative analysis; Diabetics; Drug resistance; Electronic records; Fosfomycin; Hospital patients; Imipenem; Klebsiella pneumoniae; Medical records; Medical research; Meropenem; Microbial drug resistance; Mortality; Original Research; Pneumonia; risk factor; Risk factors; Tobramycin; China; mortality; pneumonia; antimicrobial resistance; risk factor; Klebsiella pneumoniae; diabetics
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S199642

To investigate antimicrobial resistance and risk factors for mortality of (KP) pneumonia in diabetics and nondiabetics. A retrospective study was conducted among inpatients of KP pneumonia via electronic medical records in a territory hospital between January 2016 and June 2018. Antimicrobial resistance in KP pneumonia was compared between diabetics and nondiabetics. Independent risk factors for mortality in KP pneumonia were identified by univariate and multivariate logistic regression among diabetics and nondiabetics separately. In this study, 456 patients with KP pneumonia were included. There were 156 cases with diabetes and 300 without diabetes. KP showed a lower antimicrobial resistance to a multitude of antimicrobials in pneumonia among diabetics than nondiabetics, namely aztreonam, cefotetan, sulperazone, meropenem, amikacin, tobramycin, sulfamethoxazole, and fosfomycin. In addition, carbapenem-resistant (CRKP) was more prevalent among nondiabetics than diabetics who were admitted to intensive care unit (ICU) (63.0% vs 45.1%, = 0.038). Multivariable analysis showed that independent risk factors for in-hospital mortality (IHM) in KP pneumonia among diabetics differed from that among nondiabetics as well. Independent predictors for IHM of KP pneumonia among diabetics were male (OR: 5.89, 95% CI: 1.34-25.93, = 0.019), albumin (ALB) < 35 g/L (OR: 7.00, 95% CI: 2.02-24.28, = 0.002), bloodstream infection (BSI) (OR: 21.14, 95% CI: 3.18-140.72, = 0.002), and invasive ventilation during hospitalization (OR: 8.00, 95% CI: 2.99-21.42, < 0.001). In nondiabetics, independent predictors were higher CURB-65 score (OR: 1.92, 95% CI: 1.29-2.86, = 0.001), CRKP (OR: 2.72, 95% CI: 1.07-6.90, = 0.035), BSI (OR: 4.98, 95% CI: 1.34-18.50, = 0.017), and ICU admission (OR: 4.06, 95% CI: 1.57-10.47, = 0.004). In KP pneumonia, diabetics showed lower antimicrobial resistance and different independent risk factors for mortality compared with nondiabetics, in line with previous studies. Importantly, further attention should be paid on rational and effective antibiotic and supportive treatments in order to reduce mortality without aggravating antimicrobial resistance and metabolic damage among diabetics.