Preliminary exploration on the serum biomarkers of bloodstream infection with carbapenem‐resistant Klebsiella pneumoniae based on mass spectrometry

Abstract Background Appropriate therapy for carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is often given late in the course of infection, and strategies for identifying CRKP BSI earlier are needed. Methods A retrospective case–control study was performed at a tertiary care hospital, university hospital, and community hospital in Bronx, New York. All participants had a blood culture sent and received an antibiotic within 48 hours of the culture. The case group (n = 163) had a blood culture with CRKP. The control group (n = 178) had a blood culture with carbapenem-susceptible Klebsiella. Data were obtained by electronic or conventional medical record abstraction. A multiple logistic regression model was built to identify associated factors and develop a clinical model for CRKP BSI. Model performance characteristics were estimated using a 10-fold cross-validation analysis. Results A prior nonblood culture with carbapenem-resistant Enterobacteriaceae, skilled nursing facility (SNF) residence, mechanical ventilation, and admission >3 days were strongly associated risk factors. A significant interaction led to development of separate clinical models for subjects admitted <3 days at the time of positive blood culture from those admitted at least 3 days. The derived models had a good ability to discriminate between subjects with and without CRKP BSI. A clinical classification rule to guide therapy can prioritize sensitivity or specificity. Conclusions Prior nonblood cultures showing resistance and exposure to SNF and health care settings are factors associated with carbapenem resistance. The clinical classification rules derived in this work should be validated for ability to guide therapy.

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Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study

Clinical Microbiology and Infection ◽

10.1111/1469-0691.12747 ◽

2014 ◽

Vol 20 (12) ◽

pp. 1357-1362 ◽

Cited By ~ 90

Author(s):

M. Giannella ◽

E.M. Trecarichi ◽

F.G. De Rosa ◽

V. Del Bono ◽

M. Bassetti ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Multicentre Study ◽

Bloodstream Infection ◽

Carbapenem Resistant

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Clinical characteristics and risk factors associated with secondary bloodstream infection in patients with intensive care unit-acquired pneumonia due to carbapenem-resistant Klebsiella pneumoniae

Chinese Medical Journal ◽

10.1097/cm9.0000000000001444 ◽

2021 ◽

Vol 134 (14) ◽

pp. 1735-1737

Author(s):

Xin-Yun Zhu ◽

Hong-Bin Wang ◽

Ye-Han Zhu ◽

Yan-Bin Chen ◽

Bei-Lei Zhang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Bloodstream Infection ◽

Clinical Characteristics ◽

Factors Associated ◽

Carbapenem Resistant

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Clinical Characteristics and Risk Factors for Bloodstream Infection Due to Carbapenem-Resistant Klebsiella pneumoniae in Patients with Hematologic Malignancies

Infection and Drug Resistance ◽

10.2147/idr.s272217 ◽

2020 ◽

Vol Volume 13 ◽

pp. 3233-3242

Author(s):

Piaopiao Zhang ◽

Jie Wang ◽

Hangbin Hu ◽

Sheng Zhang ◽

Juying Wei ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Bloodstream Infection ◽

Clinical Characteristics ◽

Hematologic Malignancies ◽

Carbapenem Resistant

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Factors Associated with Nosocomial Bloodstream Infection Caused by Carbapenem-Resistant Klebsiella pneumoniae and With Mortality, from a Single Center

Journal of Prevention and Infection Control ◽

10.21767/2471-9668.100033 ◽

2017 ◽

Vol 03 (02) ◽

Author(s):

Xiaomei Chen ◽

Jing Wang ◽

Yuan Li ◽

Jianning Zhang ◽

Hui Han ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Bloodstream Infection ◽

Single Center ◽

Nosocomial Bloodstream Infection ◽

Factors Associated ◽

Carbapenem Resistant

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

Journal of Personalized Medicine ◽

10.3390/jpm11070616 ◽

2021 ◽

Vol 11 (7) ◽

pp. 616

Author(s):

Keh-Sen Liu ◽

Yao-Shen Tong ◽

Ming-Tsung Lee ◽

Hung-Yu Lin ◽

Min-Chi Lu

Keyword(s):

Risk Factors ◽

Platelet Count ◽

Klebsiella Pneumoniae ◽

Bloodstream Infection ◽

Cox Regression ◽

Cox Regression Analysis ◽

Carbapenem Resistant ◽

All Cause Mortality ◽

Insight Into ◽

Antimicrobial Regimen

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.

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