Abstract
BackgroundThere are few studies focused on carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI). The aim of this study is to identify the prevalence and risk factors for infection and mortality of CRKP BSI.MethodsSusceptibility of Klebsiella pneumoniae (KP) isolated from blood samples and the proportion of CRKP were recorded annually. One hundred sixty-four patients with CRKP and 328 with carbapenem-susceptible Klebsiella pneumoniae (CSKP) BSI were categorized as the case group and control group to identify risk factors for CRKP infection and mortality by univariable analysis and multivariable logistic-regression analysis.ResultsThe proportion and mortality of CRKP BSI increased significantly, with the percentage of KP in BSI increasing from 7 to 12% from 2014 to 2019 with a concomitant resistance to meropenem increasing from 16.7 to 41.8%. Compared with CSKP group, patients in CRKP group had longer hospitalization time before bacteremia (median 14 vs 4, P < 0.001) and longer total hospitalization time (median 31 vs 19, P < 0.001). The proportion of admission to ICU was higher (70.7% vs 17.7%, P < 0.001), and APACHE II score was higher (median 12 vs 8, P < 0.001). The mortality in CRKP group was 43.9% (72/164), while 14.9% (49/328) in CSKP group (p < 0.001). KP detection in other sites(P = 0.036, OR 1.964), blood purification(P = 0.018, OR 3.326), bronchoscopy(P = 0.011, OR 5.423), surgery (P = 0.001, OR 3.084), carbapenem use(P = 0.001, OR 3.395), tigecycline use(P = 0.006, OR 4.595) were independent risk factors for CRKP BSI. Previous hospitalization (P = 0.048, OR 2.755), long hospitalization (P = 0.003, OR 1.035), bone marrow puncture (P = 0.037, OR3.856), use of β-lactamase inhibitor (P = 0.005, OR 3.890) were independent risk factors for mortality in CRKP BSI.ConclusionThe prevalence and mortality of CRKP BSI are still increasing. Timely treatment of KP infection in other site, strengthening the hospital infection control of blood purification, bronchoscopy and surgery, control the use of carbapenem and tigecycline, may help to prevent CRKP BSI. More preventative hospital resources are needed for severely ill patients with prolonged hospitalizations and intensive care.
Highlights
Carbapenems are the most effective and reliable βlactams for the treatment of severe infections caused by multidrug resistant Enterobacteriaceae [1, 2]
Four hundred ninety-two patients who met the criteria for bloodstream infection (BSI) included 164 (33.3%) carbapenem-resistant Klebsiella pneumoniae (CRKP) cases and 328 (66.7%) carbapenem-susceptible Klebsiella pneumoniae (CSKP) cases, among which 121 patients (24.6%) died during the current admission
The mortality of Klebsiella pneumoniae (KP) BSI has increased from 14% in 2014 to 44% in the first half of 2019
Summary
Carbapenems are the most effective and reliable βlactams for the treatment of severe infections caused by multidrug resistant Enterobacteriaceae [1, 2]. CRKP was first discovered in North Carolina in 1996, and it has become the most common type of carbapenem resistant Enterobacteriaceae (CRE) in the United States [3]. Carbapenem resistance among Klebsiella pneumoniae (KP) in the United States was as high as 12% of all isolates in 2009–2010 [8], while it was less than 1% in 2000 [3]. There are few studies focused on carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI).
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