Comparison of bloodstream and non-bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae in the intensive care unit: a 9-year respective study

Frontiers in Medicine

Medicine

Xiaocui Zou¹  Xiangyuan Sun²  Tao Yin³  Boting Zhou³  Ping Wang³ 

[1] Department of Pharmacy, Xiangya Hospital, Central South University, Changsha Hunan, China;Department of Pharmacy, Xiangya Hospital, Central South University, Changsha Hunan, China;Department of Pharmacy, Lixian People’s Hospital, Lixian, Hunan, China;Department of Pharmacy, Xiangya Hospital, Central South University, Changsha Hunan, China;National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China;

关键词: Carbapenem resistance;    Klebsiella pneumoniae;    bloodstream infection;    non-bloodstream infection;    intensive care unit;   

DOI  :  10.3389/fmed.2023.1230721

 received in 2023-06-02, accepted in 2023-08-31,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundBloodstream infections (BSIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) have received much attention. However, few studies have identified risk factors for CRKP BSIs in comparison to CRKP non-bloodstream infections (non-BSIs). This study aimed to compare the epidemiology, risk factors, and outcomes of CRKP BSIs and CRKP non-BSIs.MethodsWe conducted a retrospective study of patients infected with CRKP in the ICU from January 2012 to December 2020. Clinical characteristics and outcomes were compared between CRKP BSIs and CRKP non-BSIs. Predictors associated with 28-day all-cause mortality in CRKP-infected patients were also evaluated.Results326 patients infected with CRKP were enrolled, including 96 patients with CRKP BSIs and 230 with CRKP non-BSIs. The rates of CRKP BSIs in CRKP infections were generally raised from 2012 (12.50%) to 2020 (45.76%). Multivariate logistic analysis indicated that the use of carbapenems within the prior 90 days was an independent risk factor for CRKP BSIs (p = 0.019). Compared to CRKP non-BSIs, CRKP isolates in the CRKP BSI group were found to be non-susceptible to more tested carbapenems (p = 0.001). Moreover, the CRKP BSI group exhibited a higher mortality rate (p = 0.036). The non-susceptibility of CRKP isolates to more tested carbapenems (p = 0.025), a high SOFA score (p = 0.000), and the use of antifungal drugs within the prior 90 days (p = 0.018) were significant factors for 28-day all-cause mortality in CRKP-infected patients.ConclusionThe proportion of CRKP BSI increased progressively in CRKP-infected patients over 9 years. The use of carbapenems within the prior 90 days was an independent risk factor for the development of CRKP BSIs. The non-susceptibility of CRKP isolates to more tested carbapenems and a higher mortality rate were found in the CRKP BSI group.

【 授权许可】

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Copyright © 2023 Sun, Zou, Zhou, Yin and Wang.