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

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.

Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

2021 ◽  
Author(s):  
Yuzhen Qiu ◽  
Wen Xu ◽  
Yunqi Dai ◽  
Ruoming Tan ◽  
Jialin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill Patients ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Mortality Rates ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Independent Risk Factors

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.

scholarly journals Clinical application of the novel 4S-AF scheme for the characterisation of patients with atrial fibrillation: a report from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
W.Y Ding ◽  
M Proietti ◽  
G Boriani ◽  
F Marin ◽  
C Blomstrom-Lundqvist ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Thromboembolic Event ◽  
Stroke Risk ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
All Cause Mortality ◽  
Atrial Enlargement

Abstract Background Current classification systems recommended by major international guidelines are based on a single domain of atrial fibrillation (AF): temporal pattern, symptom severity or underlying comorbidity. Lack of integration between these various elements limits our approach to patients with AF and acts as a barrier against the delivery of better holistic care. The 4S-AF classification scheme was recently introduced as a means for the characterisation of patients with AF. It comprises of 4 domains: stroke risk (St), symptoms (Sy), severity of AF burden (Sb) and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and effects of individual domains on outcomes in AF. Methods Patients with AF from 250 centres across 27 participating European countries were included. All patients were over 18 years old and had electrocardiographic confirmation of AF within 12 months prior to enrolment. Data on demographics and comorbidities were collected at baseline. Individual domains of the 4S-AF scheme were assessed using the CHA2DS2-VASc score (St), European Heart Rhythm Association classification (Sy), temporal classification of AF (Sb), and cardiovascular risk factors and the degree of left atrial enlargement (Su). Each of these domains were used during multivariable cox regression analysis. Results A total of 6321 patients were included in the present analysis, corresponding to 57.0% of the original cohort of 11096 patients. The median age of patients was 70 (interquartile range [IQR] 62–77) years with 2615 (41.4%) females. Among these patients, 528 (8.4%) had low stroke risk (St=0), 3002 (47.5%) no or mild symptoms (Sy=0), 2558 (40.5%) newly diagnosed or paroxysmal AF (Sb=0), and 322 (5.1%) no cardiovascular risk factors or left atrial enlargement (Su=0). Median follow-up was 24 months. Using multivariable cox regression analysis, independent predictors of all-cause mortality were (St) (adjusted hazard ratio [aHR] 8.21 [95% CI, 2.60–25.9]), (Sb) (aHR 1.21 [95% CI, 1.08–1.35]) and (Su) (aHR 1.27 [95% CI, 1.14–1.41]). For cardiovascular mortality and any thromboembolic event, only (Su) (aHR 1.73 [95% CI, 1.45–2.06]) and (Sy) (aHR 1.29 [95% CI, 1.00–1.66]) were statistically important, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Conclusion Overall, we demonstrated that the 4S-AF scheme may be used to provide clinical characterisation of patients with AF using routinely collected data, and each of the domains within the 4S-AF scheme were independently associated with adverse long-term outcomes of all-cause mortality, cardiovascular mortality and/or any thromboembolic event. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Adipose tissue is a predictor of 30-days mortality in patients with bloodstream infection caused by carbapenem-resistant Klebsiella pneumoniae 

2021 ◽  
Author(s):  
weiyang cai ◽  
piaopiao ying ◽  
yinchai ye ◽  
jianzhong ye ◽  
jiajing chen
Keyword(s):  
Body Composition ◽  
Adipose Tissue ◽  
Bloodstream Infection ◽  
Cox Regression ◽  
Statistical Significance ◽  
The Body ◽  
Pneumonia Severity ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Total Adipose Tissue

Abstract Background Prevalence of CRKP bloodstream infection with high mortality has attached physicians' attention. High-VAT and high-SAT were confirmed by previous studies that closely related to increased pneumonia severity, more complications, and higher mortality in COVID-19. Thus, we speculate that CT-quantified body composition may also be connected to all-cause mortality and bacterial clearance in patients with CRKP bloodstream infection. Methods We investigated the associations of CT-quantified body composition with CRKP bloodstream infectious patients. All of the CT images were obtained at the level of the L3/4 spinal level. The prognostic value of the body composition was analyzed using the Cox regression model, and precise clinical nomograms were established. Results Factors associated with 30-day all-in hospital mortality included TAT [adjusted odds ratio (OR) = 1.028, 95% confidence interval (CI), 1.004–1.053; p = 0.028], age [OR = 1.031, 95% CI, 1.001–1.062; p = 0.046] and SOFA score [OR = 1.137, 95% CI 1.047–1.235; p = 0.002]. Compared with low-VAT, patients with high-VAT show a strikingly poor prognosis in both 30-day mortality (P = 0.0449, Fig. 2A) and all-cause mortality (P = 0.0048, Fig. 2C). The results of TAT were similar with VAT. Conclusions Our study suggests that CT-derived composition could be a credible and effective alternative to assess the prognosis of patients with BSIs owing to CRKP. CT-quantified total adipose tissue, age and SOFA scores were independently associated with 30-day all-cause mortality in these severe infectious patients, while skeletal muscle did not have obvious statistical significance.

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

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.

scholarly journals Efficacy of Ceftazidime-Avibactam Versus Polymyxin B and Risk Factors Affecting Clinical Outcomes in Patients With Carbapenem-Resistant Klebsiella pneumoniae Infections a Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jie Fang ◽  
Hui Li ◽  
Min Zhang ◽  
Guochao Shi ◽  
Mengying Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Klebsiella Pneumoniae ◽  
Polymyxin B ◽  
Therapeutic Effects ◽  
Bacterial Eradication ◽  
Factors Affecting ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Cox's Regression

Background: The worldwide outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become an urgent public health problem. High mortality and lack of effective treatments further pose new challenges to control this infection. However, studies about the evaluation of available antibiotics for CRKP infection are limited. The present study aimed to compare the efficacy of polymyxin B versus ceftazidime-avibactam (CAZ/AVI) in Chinese patients with CRKP infections and to identify risk factors affecting 7-day bacterial eradication and 28-day all-cause mortality.Methods: From January 8, 2018, to July 6, 2020, a total of 115 adult CRKP infected patients from two tertiary teaching hospitals in Shanghai, China were enrolled based on the inclusion and exclusion criteria. By reviewing electronic medical records of these patients, demographic and clinical data were extracted. The selected patients were divided into polymyxin B and CAZ/AVI groups according to primary antibiotic exposure to compare therapeutic effects. Binary logistic and cox’s regression analysis were performed to identify risk factors for 7-day bacterial eradication and all-cause mortality.Results: One hundred and five patients were treated with polymyxin B (67.8%) or CAZ/AVI (32.2%). Patients in the CAZ/AVI group had significantly lower rates of 28-day mortality (8.1 vs 29.5%, p = 0.013), higher microbiological eradication and 28-day clinical success. Multivariate analysis showed that Charlson comorbidity index (≥3) and prior antibiotic use within 90 days were independent risk factors for poor microbiological eradication. Cox’s regression analysis indicated that the length of hospitalization after CRKP infection and baseline creatinine clearance negatively affected 28-day mortality.Conclusion: CAZ/AVI was more effective than polymyxin B and appeared to be a promising drug for CRKP infection, especially for critically ill patients.

scholarly journals Adipose Tissue is a Predictor of 30-days Mortality in Patients with Bloodstream Infection Caused by Carbapenem-Resistant Klebsiella Pneumoniae

2021 ◽  
Author(s):  
piaopiao ying ◽  
jiajing chen ◽  
yinchai ye ◽  
jiayong ye ◽  
weiyang cai
Keyword(s):  
Body Composition ◽  
Adipose Tissue ◽  
Bloodstream Infection ◽  
Cox Regression ◽  
Statistical Significance ◽  
The Body ◽  
Pneumonia Severity ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Total Adipose Tissue

Abstract Background: Prevalence of CRKP bloodstream infection with high mortality has attached physicians' attention. High-VAT and high-SAT were confirmed by previous studies that closely related to increased pneumonia severity, more complications, and higher mortality in COVID-19. Thus, we speculate that CT-quantified body composition may also be connected to all-cause mortality and bacterial clearance in patients with CRKP bloodstream infection. Methods: We investigated the associations of CT-quantified body composition with CRKP bloodstream infectious patients. All of the CT images were obtained at the level of the L3/4 spinal level. The prognostic value of the body composition was analyzed using the Cox regression model, and precise clinical nomograms were established. Results: Factors associated with 30-day all-in hospital mortality included TAT [adjusted odds ratio (OR)=1.028, 95% confidence interval (CI), 1.004–1.053; p = 0.028], age [OR=1.031, 95% CI, 1.001–1.062; p = 0.046] and SOFA score [OR=1.137, 95% CI 1.047–1.235; p = 0.002]. Compared with low-VAT, patients with high-VAT show a strikingly poor prognosis in both 30-day mortality (P=0.0449, Figure 2A) and all-cause mortality (P=0.0048, Figure 2C). The results of TAT were similar with VAT. Conclusions: Our study suggests that CT-derived composition could be a credible and effective alternative to assess the prognosis of patients with BSIs owing to CRKP. CT-quantified total adipose tissue, age and SOFA scores were independently associated with 30-day all-cause mortality in these severe infectious patients, while skeletal muscle did not have obvious statistical significance.

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