ABSTRACT
Bloodstream infections caused by multidrug-resistant organisms such as Klebsiella pneumoniae are a significant challenge in managing hematological malignancies. This study aims to characterize the epidemiology of Klebsiella pneumoniae bloodstream infections specifically in patients with hematological malignancies, delineate the patterns of initial antibiotic therapy, assess the prevalence of resistant strains, identify risk factors for these resistant strains, and evaluate factors influencing patient outcomes. A retrospective analysis was conducted at a single center from January 2017 to December 2020, focusing on 182 patients with hematological malignancies who developed Klebsiella pneumoniae bloodstream infections. We compared the 30-day mortality rates between patients receiving appropriate and inappropriate antibiotic treatments, including the effectiveness of both single-drug and combination therapies. Kaplan-Meier survival analysis and multivariate logistic and Cox regression were used to identify factors influencing mortality risk. The 30-day all-cause mortality rate was 30.2% for all patients. The 30-day all-cause mortality rates were 77.2% and 8.8% in patients who received inappropriate initial treatment and appropriate initial treatment (p < 0.001). Inappropriate initial treatment significantly influenced mortality and was a key predictor of 30-day mortality, along with septic shock and previous intensive care unit (ICU) stays. Patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections exhibited more severe clinical symptoms compared to the CSKP group. The study demonstrates a significant association between empirical carbapenem administration and the escalating prevalence of CRKP and multidrug-resistant K. pneumoniae (MDR-KP) infections. Furthermore, the study identified inappropriate initial antibiotic therapy, septic shock, and ICU admission as independent risk factors for 30-day mortality.
Subject(s)
Anti-Bacterial Agents , Bacteremia , Hematologic Neoplasms , Klebsiella Infections , Klebsiella pneumoniae , Humans , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/isolation & purification , Male , Female , Klebsiella Infections/drug therapy , Klebsiella Infections/mortality , Middle Aged , Hematologic Neoplasms/complications , Hematologic Neoplasms/mortality , Hematologic Neoplasms/drug therapy , Anti-Bacterial Agents/therapeutic use , Retrospective Studies , Aged , Bacteremia/drug therapy , Bacteremia/mortality , Bacteremia/microbiology , Risk Factors , Adult , Drug Resistance, Multiple, BacterialABSTRACT
Purpose: In view of the fact that Acinetobacter baumannii bloodstream infection(BSI) is a great threat to human survival, early identification of the risk factors affecting prognosis will be of great benefit to the clinic. Patients and Methods: A propensity score matching method was used to collect patients identified with Acinetobacter baumannii BSI from 2016 to 2020 from a reputable hospital in China. Results: A total of 398 patients were considered. According to the 28-day prognosis, they were divided into the survival group 150 (37.7%) and the death group 248 (62.3%), and the prognosis was analyzed. Subsequently, Propensity score matching was adjusted for variables with p-values
