Five-year change of prevalence and risk factors for infection and mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in a tertiary hospital in North China

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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Molecular Epidemiology, Risk Factors and Outcomes of Carbapenem-Resistant Klebsiella Pneumoniae Infection in Eastern China: for A Retrospective Study Over 4 Years

10.21203/rs.3.rs-71433/v1 ◽

2020 ◽

Author(s):

Dongmei Zhao ◽

Hongru Li ◽

Chengcheng Yue ◽

Yanyan Liu ◽

Ying Ye ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Dominant Role ◽

Eastern China ◽

Tertiary Hospital ◽

Empirical Treatment ◽

Carbapenem Resistant ◽

Carbapenemase Gene ◽

Significant Difference ◽

Hospital Stays

Abstract Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) have undergone extensive dissemination in worldwide resulting in increased mortality. We performed a retrospective analysis of epidemiology and risk factors for CRKP infection in a general teaching hospital in China.Methods: A molecular and clinical study were conducted for 98 CRKP in a tertiary hospital from January 2013 to December 2016. Carbapenemase gene detection, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed. Logistic regression was also used to identify the risk factors associating with the 30-day mortality.Results: The producition of KPC cabapenemase was the main resistant mechanism and increased annually with a significant difference. However, the molecular outcome revealed the dominance and diversity in CRKP with 24 sequence types (STs) and 59 PFGE types (PTs ). The ST11 CRKP were documented as the predominant strains in our study, which showed a significant increasing trend year by year. Additionally, the predominant ST11 CRKP corresponding to PT10 and PT15 remained a typical fashion. Of note, the new advantage PT09 or PT16 were just discovered in 2016 which also corresponding to ST11. Meanwhile, the factors on 30-day mortality and ST11 proportionality with CRKP infection were assessed, which showed that ST11, appropriate empirical treatment, and hospital stays were independently associated with 30-day mortality. Conclusions: ST11 CRKP payed a dominant role in the process, but the homology of these strains was polymorphic and the advantage clusters would be changed by evolution. Additionally, besides appropriate empirical treatment and hospital stays, ST11 CRKP was independently associated with the 30-day mortality, first reported as we know.

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Risk factors for recurrent carbapenem resistant Klebsiella pneumoniae bloodstream infection: a prospective cohort study

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-017-3020-x ◽

2017 ◽

Vol 36 (10) ◽

pp. 1965-1970 ◽

Cited By ~ 8

Author(s):

Maddalena Giannella ◽

Elena Graziano ◽

Lorenzo Marconi ◽

Nicolo Girometti ◽

Michele Bartoletti ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Klebsiella Pneumoniae ◽

Bloodstream Infection ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Carbapenem Resistant

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Clinical and Bacterial Characteristics of Klebsiella pneumoniae Affecting 30-Day Mortality in Patients With Bloodstream Infection

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.688989 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xingbing Wu ◽

Qingyi Shi ◽

Shimo Shen ◽

Chen Huang ◽

Hongcheng Wu

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Klebsiella Pneumoniae ◽

Bloodstream Infection ◽

High Mortality ◽

Virulence Genes ◽

Genomic Analysis ◽

Apache Ii Score ◽

Comparative Genomic ◽

Carbapenem Resistant

BackgroundThere is a paucity of studies using clinical characteristics and whole-genome sequencing together to fully identify the risk factors of patients with Klebsiella pneumoniae (KP) bloodstream infection (BSI).MethodsWe retrospectively analyzed the clinical and microbiological characteristics of patients with KP BSI. Isolates were processed using Illumina NGS, and relevant bioinformatics analysis was conducted (multi-locus sequence typing, serotype, phylogenetic reconstruction, detection of antibiotic resistance, and virulence genes). A logistic regression model was used to evaluate the risk factors of hosts and causative KP isolates associated with 30-day mortality in patients infected with KP BSI.ResultsOf the 79 eligible patients, the 30-day mortality rate of patients with KP BSI was 30.4%. Multivariate analysis showed that host-associated factors (increased APACHE II score and septic shock) were strongly associated with increased 30-day mortality. For the pathogenic factors, carriage of iutA (OR, 1.46; 95% CI, 1.11–1.81, p = 0.002) or Kvar_1549 (OR, 1.31; 95% CI, 1.02–1.69, p = 0.043) was an independent risk factor, especially when accompanied by a multidrug-resistant phenotype. In addition, ST11-K64 hypervirulent carbapenem-resistant KP co-harbored acquired blaKPC-2 together with iutA (76.5%, 13/17) and Kvar_1549 (100%, 17/17) genes. Comparative genomic analysis showed that they were clustered together based on a phylogenetic tree, and more virulence genes were observed in the group of ST11-K64 strains compared with ST11-non-K64. The patients infected with ST11-K64 strains were associated with relatively high mortality (47.2%, 7/17).ConclusionThe carriage of iutA and Kvar_1549 was seen to be an independent mortality risk factor in patients with KP BSI. The identification of hypervirulent and carbapenem-resistant KP strains associated with high mortality should prompt surveillance.

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

10.21203/rs.3.rs-29375/v1 ◽

2020 ◽

Author(s):

Piaopiao Zhang ◽

Jie Wang ◽

Hangbin Hu ◽

Sheng Zhang ◽

Juying Wei ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Bloodstream Infection ◽

Hematologic Malignancy ◽

Invasive Mechanical Ventilation ◽

Hematologic Malignancies ◽

Severe Neutropenia ◽

Total Risk ◽

Retrospective Case ◽

Carbapenem Resistant

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) associated infections are a major threat to patient safety. Methods: A single-center, retrospective case-control study representing 734 patients with hematologic malignancies between January 1, 2017 and December 31, 2018 was conducted. Demographic and clinical data were collected from the hospital electronic medical records system. Results: Among the 734 patients with hematologic malignancies, 3% (22/734) of the patients developed CRKP BSI during their hospitalization. Overall 28-day all-cause mortality reached 77.3% (17/22). Patients with Pitt Bacteremia Score (PBS) >4, pneumonia and septic shock were more frequent in the non-survivors versus the survivors . Compared with the non-survivors in antimicrobial treatment, combination therapy of tigecycline and polymyxin B was more common in the survivors. The independent risk factors associated with CRKP BSI were CRKP rectal colonization (OR,11.067; CI=4.43-27.644; P<0.001; 3 points), severe neutropenia (OR,4.095; CI=0.876-19.141; P=0.073; 1 point) and invasive mechanical ventilation (IMV) within the previous 30 days to onset of BSI (OR,18.444; CI=1.787-190.343; P=0.014; 4 points). The total risk score of ≥5 indicated that the probability of CRKP BSI occurrence was above 48%. Conclusions: CRKP BSI in patients with hematologic malignancies is associated with high mortality. The risk factor–based prediction model might help clinicians to start prompt effective anti-infective therapy in patients with suspicion of CRKP BSI and improve outcomes. Keywords: Carbapenem-resistant Klebsiella pneumoniae ; bloodstream infection; hematologic malignancy; risk factors; prediction

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