Abstract
ObjectiveCarbapenem-resistant Klebsiella pneumoniae (CRKP) infections are associated with poor patient outcomes. We aimed to analyze the clinical information of adult patients with CRKP infection in order to establish a nomogram for mortality risk as well as to determine the treatment effectiveness of different antimicrobial regimens.MethodsAdult patients diagnosed with CRKP infection in a tertiary hospital in Shanghai between September 2019 and March 2021 were included. The clinical characteristics and clinical outcomes of these patients were analyzed.ResultsA total of 199 cases of CRKP infection were examined. Five factors, namely age ≥65 years, respiratory failure, Sequential Organ Failure Assessment score, serum procalcitonin ≥5 ng/mL, and appropriate treatments in 3 days, were found to be associated with 30-day mortality. Upon incorporating these factors, the nomogram achieved good concordance indexes of 0.85 (95% confidence interval [CI]: 0.80–0.90) and well-fitted calibration curves. Receiver-operating characteristic curves for 7-, 15-, and 30-day survival had areas under the curve of 0.90, 0.87, and 0.88, respectively. Three-drug combination therapy was observed to be associated with lower mortality in the high-risk group (adjusted hazard ratio = 0.24, 95% CI: 0.06–0.99) but not in the low-risk group. Ceftazidime–avibactam, fosfomycin, and amikacin were effective against infections caused by CRKP. Tigecycline improved the treatment efficiency in 7 days, but a trend toward increased mortality was seen (HR, 1.69; 95% CI: 0.98–2.94; P = 0.061).ConclusionThe antimicrobial regimen efficacy data and the predictive nomogram established in this study can help clinicians in identifying high-risk adult patients with CRKP infection, improving the therapeutic effect, and reducing mortality.
Highlights
Klebsiella pneumoniae (KP) is one of the most common pathogens associated with nosocomial infections such as pneumonia, urinary tract infections, bloodstream infections, and sepsis (Bengoechea and Sa Pessoa, 2019; Rodrıǵ uez-Medina et al, 2019)
The above independent factors, along with age > 65 years (HR, 2.03; 95% confidence intervals (CIs): 0.83–4.98; P < 0.121), were used to establish the nomograms to predict the mortality in the patients with Carbapenem-resistant KP (CRKP) (Figure 2)
The results showed that ceftazidime–avibactam, fosfomycin, and amikacin were effective against infections caused by CRKP, which is consistent with the survival analysis and the findings of our previous study (Yao et al, 2021)
Summary
Klebsiella pneumoniae (KP) is one of the most common pathogens associated with nosocomial infections such as pneumonia, urinary tract infections, bloodstream infections, and sepsis (Bengoechea and Sa Pessoa, 2019; Rodrıǵ uez-Medina et al, 2019). CRKP infections have emerged as an important public health threat over the past decade in China owing to the limited treatment options and unsatisfactory outcomes (Durante-Mangoni et al, 2019; Tsioutis et al, 2021). Existing antibiotics such as tigecyclines, polymyxins, fosfomycin, and aminoglycosides are the currently available therapeutic options for CRKP infections, while ceftazidime–avibactam is a newly developed antibiotic (Tilahun et al, 2021). A comprehensive understanding of the clinical features, risk factors, and outcomes of patients with CRKP infection are important. There is an urgent need to establish a scoring system for predicting mortality to assess the severity of the illness and the risk of mortality
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