Risk factors for the development of carbapenem-resistant Klebsiella pneumoniae infections in critically ill patients

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

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Risk factors for hospital-acquired pneumonia caused by carbapenem-resistant Gram-negative bacteria in critically ill patients: a multicenter study in Korea

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2013.08.011 ◽

2014 ◽

Vol 78 (4) ◽

pp. 457-461 ◽

Cited By ~ 18

Author(s):

Tark Kim ◽

Yong Pil Chong ◽

Seong Yeon Park ◽

Min-Hyok Jeon ◽

Eun Joo Choo ◽

...

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Multicenter Study ◽

Critically Ill Patients ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Carbapenem Resistant ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired

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Molecular epidemiology and risk factors for colistin- or tigecycline-resistant carbapenemase-producing Klebsiella pneumoniae bloodstream infection in critically ill patients during a 7-year period

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2018.06.001 ◽

2018 ◽

Vol 92 (3) ◽

pp. 235-240 ◽

Cited By ~ 5

Author(s):

Matthaios Papadimitriou-Olivgeris ◽

Christina Bartzavali ◽

Aikaterini Spyropoulou ◽

Anastasia Lambropoulou ◽

Nektarios Sioulas ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Molecular Epidemiology ◽

Bloodstream Infection ◽

Critically Ill ◽

Critically Ill Patients

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Does Antimicrobial Therapy Affect Mortality of Patients with Carbapenem-Resistant Klebsiella pneumoniae Bacteriuria? A Nationwide Multicenter Study in Taiwan

Microorganisms ◽

10.3390/microorganisms8122035 ◽

2020 ◽

Vol 8 (12) ◽

pp. 2035

Author(s):

Chien Chuang ◽

Chin-Fang Su ◽

Jung-Chung Lin ◽

Po-Liang Lu ◽

Ching-Tai Huang ◽

...

Keyword(s):

Regression Analysis ◽

Klebsiella Pneumoniae ◽

Critically Ill ◽

Antimicrobial Therapy ◽

Critically Ill Patients ◽

Cox Regression ◽

Apache Ii ◽

Apache Ii Score ◽

Cox Regression Analysis ◽

Carbapenem Resistant

Few clinical studies have previously discussed patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteriuria. This study aimed to assess the effect of antimicrobial therapy on the mortality of patients with CRKP bacteriuria. Hospitalized adults with CRKP bacteriuria were enrolled retrospectively from 16 hospitals in Taiwan during 2013 and 2014. Critically ill patients were defined as those with an Acute Physiology and Chronic Health Evaluation (APACHE) II score ≥ 20. Multivariate Cox regression analysis was used to determine independent risk factors for 14- and 28-day mortality. Of 107 patients with CRKP bacteriuria, the 14-day and 28-day mortality was 14.0% and 25.2%, respectively. Thirty-three patients received appropriate antimicrobial therapy. In the multivariate Cox regression analysis, the APACHE II score ≥ 20 was the only independent risk factor for 14-day mortality (hazard ratio [HR]: 6.15, p = 0.024). APACHE II score ≥ 20 (HR: 3.05, p = 0.018) and male sex (HR: 2.57, p = 0.037) were associated with 28-day mortality. Among critically ill patients with CRKP bacteriuria, appropriate antimicrobial therapy was not associated with 14-day or 28-day survival. In conclusion, in patients with CRKP bacteriuria, the use of appropriate antimicrobial therapy was not an independent factor associated with reduced mortality. Our findings may inform future antibiotic stewardship interventions for bacteriuria caused by multidrug resistant pathogens.

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