A Retrospective Analysis of Risk Factors and Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Bacteremia in Nontransplant Patients. (16th March 2020)

• Record Type: Journal Article
• Authors: Xiao, Tingting; Zhu, Yunying; Zhang, Shuntian; Wang, Yuan; Shen, Ping; Zhou, Yanzi; Yu, Xiao; Xiao, Yonghong
• Is Part Of: Journal of infectious diseases. Volume 221(2020)Supplement 2
• Page Start: S174
• Page End: S183
• Publication Date: 2020-03-16
• Subjects: carbapenem resistant -- Klebsiella pneumoniae -- nontransplant; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiz559
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: Carbapenem-resistant Klebsiella pneumoniae ( CRKP ) has become a major problem among nosocomial infections, and it is a serious threat to patients. The clinical characteristics and outcome of CRKP bloodstream infection (BSI) in nontransplant patients remains unelucidated. The aim of this study was as follows: identify the risk factors of CRKP infection; generate new ideas for prevention; and generate new ideas for the most effective therapeutic management in nontransplant patients. Methods: The study retrospectively analyzed the clinical and microbiological data of nontransplant patients with K pneumoniae ( KP ) bacteremia from January 2013 to December 2015 to identify risk factors, clinical features, and outcomes using multivariate logistic regression analysis. Results: Of the 371 patients with KP -BSI in nontransplant patients included in this study, 28.0% (N = 104) had CRKP . The 28-day mortality was higher in patients infected with CRKP (55.8%) than in those with carbapenem-susceptible KP (13.9%) ( P < .001). Multivariate analysis showed previous gastric catheterization, previous use of carbapenems, hypoproteinemia, and high Acute Physiologic Assessment and Chronic Health Evaluation II scores as independent risk factors for CRKP -BSIs. Carbapenem-resistant KP infection, severe illness, and tigecycline therapy were independent risk factors for death from KP -BSIs. Taken together, inappropriate antibiotic treatment both in empirical and definitive therapy and imipenem minimum inhibitory concentrations (MICs) of >8 mg/L were associated with poor clinical outcome. Conclusions: Nontransplant patients with CRKP -BSI had higher mortality. Carbapenems exposure was an independent risk factor for CRKP infection. Imipenem MICs of >8 mg/L, tigecycline therapy, and inappropriate treatments increased the 28-day mortality of KP -BSI patients.