Factors associated with prognosis of carbapenem-resistant Klebsiella pneumoniae bloodstream infection / 中华传染病杂志

ABSTRACT

Objective:To analyze the clinical characteristics and the risk factors for poor prognosis of patients with bloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP), and to guide clinical treatment. Methods:The clinical characteristics, co-infection sites, comorbidities, laboratory tests, and antimicrobial drug exposure of adult patients with CRKP BSI admitted to The First Affiliated Hospital of Anhui Medical University from August 2015 to August 2020 were retrospectively analyzed. The patients were divided into good prognosis group and poor prognosis group. The clinical data of the two groups were compared. Statistical analysis was performed using Mann-Whitney U test and chi-square test. Binary logistic regression was used to analyze the risk factors for poor prognosis in patients with CRKP BSI. Results:Among the 106 CRKP BSI patients, 47 were in the good prognosis group and 59 were in the poor prognosis group. The length of hospital stay (39(22, 89) d vs 21(15, 38) d), the ratio of history of admission within 90 days (17.0%(8/47) vs 35.6%(21/59)), the ratio of history of carbapenems exposure (42.6%(20/47) vs 64.4%(38/59)), the ratio of complicated with lower respiratory tract infection (44.7%(21/47) vs 78.0%(46/59)), the ratio of admission to intensive care unit (34.0%(16/47) vs 81.4%(48/59)), the ratio of septic shock (19.1%(9/47) vs 69.5%(41/59)), the ratio of complicated with multiple organ dysfunction syndrome (MODS) (10.6%(5/47) vs 74.6%(44/59)), the ratio of solid organ transplantation status (40.4%(19/47) vs 18.6%(11/59)), the ratio of surgery (51.1%(24/47) vs 32.2%(19/59)), the ratio of mechanical ventilation (23.4%(11/47) vs 74.6%(44/59)), the Pitt bacteremia scores ≥4 points (21.3%(10/47) vs 69.5%(41/59)), the quick sequential organ failure assessment (qSOFA) scores ≥2 points (14.9%(7/47) vs 81.4%(48/59)), the ratio of platelets counts<100×10 9/L (31.9%(15/47) vs 62.7%(37/59)) had statistical differences between the poor prognosis group and the good prognosis group ( Z=-3.72, χ2=4.54, 5.04, 12.46, 24.48, 26.61, 43.02, 6.12, 3.86, 27.44, 24.36, 46.29 and 9.93, respectively; all P<0.050). Multivariate analysis showed that BSI complicated with lower respiratory tract infection (odds ratio ( OR)=3.293, 95% confidence interval ( CI) 1.138 to 9.528, P=0.028) and MODS ( OR=21.750, 95% CI 7.079 to 66.829, P<0.001) were independent risk factors for poor prognosis of CRKP BSI. Conclusions:Patients with CRKP BSI complicated with lower respiratory tract infection are more likely to have a poor prognosis. Timely maintenance of organ function may improve the prognosis of CRKP BSI.