Clinical and virulence factors related to the 30-day mortality of Klebsiella pneumoniae bacteremia at a tertiary hospital: a case–control study

Abstract

Purpose: Klebsiella pneumoniae bacteremia is a critical clinical presentation that is associated with high mortality. However, extremely few studies have investigated the virulence factors related to mortality of K. pneumoniae bacteremia in patients. The present study elucidated clinical and virulence factors associated with the 30-day mortality of K. pneumoniae bacteremia at a tertiary hospital. Methods: The medical records of 129 patients with K. pneumoniae bacteremia admitted to Osaka City University Hospital between January 2012 and December 2018 were retrospectively reviewed. Patient background characteristics, antimicrobial regimens, and prognosis were evaluated. Additionally, virulence factors were assessed using multiplex polymerase chain reaction to elucidate their association with K. pneumoniae. Results: The 30-day mortality was 10.9% in patients with K. pneumoniae bacteremia. The male-to-female ratio, age, and underlying disease did not differ between the non-survivor and survivor groups. Multivariate analysis showed that sepsis [odds ratio (OR), 7.46; p = 0.005] and iutA (OR, 4.47; p = 0.046) were independent predictors associated with the 30-day mortality of K. pneumoniae bacteremia. Conclusion: Despite the relatively low 30-day mortality of patients with K. pneumoniae bacteremia, the treatment of those with sepsis and those infected with K. pneumoniae harboring iutA may require careful management for improving their outcomes.

Antibiotic Susceptibility, Virulome, and Clinical Outcomes in European Infants with Bloodstream Infections Caused by Enterobacterales

“…In a large prospective study investigating the main determinants for adverse outcome in patients with K. pneumoniae BSIs, the cytotoxicity pks gene cluster carriage by causative strains was an independent risk factor for 30-day mortality when accompanied by MDR [38]. Lastly, the siderophore-related iutA gene was found to be an independent predictor of the 30-day mortality in K. pneumoniae bacteremia [39]. However, almost all of these studies were conducted with pre-selected virulence genes searched by polymerase chain reaction (PCR) rather than sequencing the entire bacterial virulome.…”

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

“…Most previous studies have reported that severity of underlying disease, intensive care unit (ICU) stay at infection onset, infection with extended-spectrum β-lactamase (ESBL)-producing or carbapenem-resistant KP (CRKP), and delayed administrations of appropriate therapy are the common risk factors for mortality in patients with KP BSIs ( Viale et al, 2013 ). Among the pathogenic factors, studies focusing on the virulence factors related to mortality in patients with KP BSI are scarce ( Kim et al, 2019 ; Namikawa et al, 2019 ). Kim et al indicated that carriage of the pks gene cluster was a relevant marker of early mortality using multivariate Cox hazards modeling ( Kim et al, 2019 ).…”

“…Kim et al indicated that carriage of the pks gene cluster was a relevant marker of early mortality using multivariate Cox hazards modeling ( Kim et al, 2019 ). Another study of multivariate analysis showed that iutA was an independent predictor associated with increased 30-day mortality in patients with KP BSIs ( Namikawa et al, 2019 ). Notably, the virulence genes detected in previous studies were assessed by PCR, which may not fully address the clinically important genes influencing KP pathogenicity and virulence.…”

Current Positioning against Severe Infections Due to Klebsiella pneumoniae in Hospitalized Adults

“…The mortality reported in the literature ranges from 10.9% and 69.3%; this broad variation is in accordance with significant differences in the populations across the different studies included in terms of severity, need for ICU admission and percentage of strains with resistance mechanisms [ 46 , 47 , 48 ].…”

“…Predicted admission to the ICU was analyzed in 309 cases of bacteremia for K pneumoniae : 58 (18.8%) required ICU admission and only the pulmonary site revealed a clear association [ 49 ]. Several clinical issues have revealed a prognostic capacity for the following factors: female sex, age above 65, severity scales, use of corticosteroids, active neoplasia, severity of infection (sepsis/septic shock), respiratory site, gastrointestinal site other than the hepatobiliary system, need for mechanical ventilation and parenteral nutrition [ 47 , 49 , 50 , 51 ]. History of immunosuppression, high scores on prognostic scales and severity of infection are the most common factors with more overwhelming associations.…”