Abstract
Carbapenem-resistant Klebsiella pneumoniae (KP) serves as a major threat to onco-hematological patients, resulting in great morbidity and mortality. The purpose of our study was to identify the risk factors for KP bloodstream infections (BSIs) and mortality in onco-hematological patients. A retrospective observation study was conducted on KP BSIs in the onco-hematology departments at Xiangya hospital from January 2014 to September 2018. Multivariate analysis was employed to identify the independent risk factors for carbapenem-resistant (CR) KP BSIs and related mortality. A total of 89 strains of KP were analyzed in our study, in which 20 strains were CRKP. The only risk factor for CRKP BSI was carbapenem exposure within 30 days before the onset of BSIs (HR 25.122). The 30-day mortality was 24.7%. CRKP caused more mortality than carbapenem-susceptible KP (55.0% vs 15.9%, P = 0.001). In the multivariate analysis, unresolved neutropenia (HR 16.900), diarrhea (HR 3.647) and RDW > 14% (HR 6.292) were independent risk factors for mortality, and appropriate empirical therapy (HR 0.164) was protective against mortality. Our findings showed that carbapenem resistance was spreading in our setting, and a precise combination of antibiotics covering the common pathogen is crucial to improving patient survival.
Highlights
Carbapenem-resistant Klebsiella pneumoniae (KP) serves as a major threat to onco-hematological patients, resulting in great morbidity and mortality
Between January 2014 and September 2018, 89 onco-hematological patients with K. pneumoniae bacteremia were included in our study
81/89 (91.0%) of all patients were neutropenic at the onset of bloodstream infections (BSIs), with a mean duration of 16.5 days (16.5 ± 9.5), and in 28/89 (31.5%) patients, neutropenia was considered unresolved
Summary
Carbapenem-resistant Klebsiella pneumoniae (KP) serves as a major threat to onco-hematological patients, resulting in great morbidity and mortality. The purpose of our study was to identify the risk factors for KP bloodstream infections (BSIs) and mortality in oncohematological patients. Multivariate analysis was employed to identify the independent risk factors for carbapenem-resistant (CR) KP BSIs and related mortality. Klebsiella pneumoniae resistant to carbapenem (CRKP) has been reported worldwide, including in China. Because of the few antibiotics available, CRKP has become a major threat to patients with onco-hematological disorders, resulting in high mortality [3,4]. Limited information has been reported regarding the epidemiology, outcomes and risk factors for K. pneumoniae bacteremia among patients with onco-hematological disorders
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