Risk Factors of 30-Day All-Cause Mortality in Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection.

Yao-Shen Tong,Hung-Yu Lin,Keh-Sen Liu,Ming-Tsung Lee,Min-Chi Lu

doi:10.3390/jpm11070616

Abstract

An optimal antimicrobial regimen for the treatment of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is currently unavailable. This study aimed to identify the appropriate antibiotics and the risk factors of all-cause mortality for CRKP BSI patients. This retrospective cohort study included the hospitalized patients with CRKP BSI. Primary outcome was 30-day all-cause mortality. Cox regression analysis was used to evaluate the risk factors of 30-day mortality. A total of 89 patients were included with a 30-day mortality of 52.1%. A total of 52 (58.4%) patients were treated with appropriate antimicrobial regimens and 58 (65.2%) isolates carried blaKPC-2 genes. Microbiologic eradication within 7 days (adjusted hazard ratio [HR] = 0.09, p < 0.001), platelet count (per 1 × 104/mm3, adjusted HR = 0.95, p = 0.002), and Pitt bacteremia scores (adjusted HR = 1.40, p < 0.001) were independently associated with 30-day all-cause mortality. No effective antimicrobial regimens were identified. In conclusion, risk factors of 30-day mortality in patients with CRKP BSI included microbiologic eradication > 7 days, lower platelet count, and a higher Pitt bacteremia score. These findings render a new insight into the clinical landscape of CRKP BSI.

Highlights

Introduction iationsThe rapidly increasing prevalence of antibiotic resistance in Enterobacteriaceae is currently a major threat to public health worldwide [1]
The lack of microbiologic eradication within 7 days, a lower platelet count, and a carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is a clinical challenge as no effective antimicrobial regimens are currently available
All the Klebsiella pneumoniae carbapenemase (KPC) genes detected in this study were blaKPC-2, which was consistent with the previous nationwide surveillance in Taiwan that blaKPC-2 accounted for the majority of KPC genes [28]

Summary

Introduction

The rapidly increasing prevalence of antibiotic resistance in Enterobacteriaceae is currently a major threat to public health worldwide [1]. The European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) Working Group investigated. 2703 clinical isolates of carbapeneme-resistant Enterobacteriaceae (CRE) submitted from 455 sentinel hospitals in 36 countries and reported that 15% of these were Escherichia coli and. Among these Klebsiella isolates, 37% were carbapenemaseproducers [2]. Four gene families encoding carbapenemase-production have been identified: Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase, oxacillinase 48-like, and Verona integron-encoded metallo-β-lactamase [2]. Klebsiella pneumoniae (CRKP) has attracted particular attention since it was first identified as one of the multidrug resistant bacteria strains [3]. Previous studies reported that the Licensee MDPI, Basel, Switzerland

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