Risk factors and mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in a tertiary-care hospital in China: an eight-year retrospective study

• Published in: Antimicrobial resistance & infection control Vol. 11; no. 1; p. 161
• Main Authors: Chen, Jie, Ma, Hua, Huang, Xiaoming, Cui, Yanhui, Peng, Wenzhong, Zhu, Fei, Ma, Shiyang, Rao, Minjun, Zhang, Peipei, Yang, Hang, Su, Longxiang, Niu, Ruichao, Pan, Pinhua
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 19.12.2022; BioMed Central; BMC
• Subjects: Adult; Antibiotics; Antimicrobial agents; Bacteremia - epidemiology; Bacterial pneumonia; Bloodstream infection; Carbapenem resistance; Carbapenem-Resistant Enterobacteriaceae; Carbapenems - therapeutic use; China; China - epidemiology; Comorbidity; Corticoids; Diabetes; Disease control; Drug resistance; E coli; Gram-negative bacteria; Health aspects; Hematologic Neoplasms - complications; Hospitals; Humans; Imipenem; Information systems; Intensive care units; Kidney diseases; Klebsiella pneumoniae; Laboratories; Medical records; Mortality; Nosocomial infections; Pathogens; Patients; Pneumonia; Prevalence studies (Epidemiology); Regression analysis; Retrospective Studies; Risk Factors; Sepsis; Sepsis - drug therapy; Septic shock; Shock, Septic; Statistical analysis; Surveillance; Tertiary Care Centers; Ventilators; China; Intensive care units; Carbapenem resistance; Bloodstream infection; Mortality; Klebsiella pneumoniae; Risk factors
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-022-01204-w

The prevalence of carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) is increasing worldwide. CRKP-BSI is associated with high rates of morbidity and mortality due to limited antibiotic choices. Here, we aim to identify the prevalence and risk factors for infection and mortality of CRKP BSI. This was a retrospective study of the past data from January 1st, 2012 to December 31st, 2019 of adult patients with KP-BSI in Xiangya Hospital, China. Among the 706 incidences included in this study, 27.4% of them (212/753) being CR-KP strains. The occurrence of CRKP-BSI was increased from 20.69 to 37.40% from 2012 to 2019. Hematologic malignancies and ICU acquired infection were identified to be substantial risk factors of carbapenem resistance. The overall 28-day mortality rates of CRKP-BSI patients was significantly higher than that of CSKP-BSI (P < 0.001). Logistic regression analysis identified severe sepsis or septic shock incidents, inadequate empirical antimicrobial therapy and corticosteroids use preceding infection onset as the independent predictors of 28-day mortality of CRKP-BSI patients. However, high dose carbapenem combination therapy was identified as anticipated factors of low 28-day mortality. The occurrence of CRKP-BSI was significantly increased during the study period. Hematologic malignancies and ICU acquired infection were associated with the development of CRKP BSI. Severe sepsis or septic shock incidents, inadequate empirical antimicrobial therapy and corticosteroids use preceding infection onset caused significant increase of mortality rates in CRKP-BSI patients. High dose carbapenem combination therapy was associated with better outcome.