<p>Risk Factors for Carbapenem-Resistant <em>Klebsiella pneumoniae</em> Bloodstream Infections and Outcomes</p>

Abstract

The incidence of carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSIs) is increasing globally; however, little has been reported on the risk factors and outcomes of CRKP BSIs in central China. This study aimed to determine the clinical risk factors for CRKP BSIs and the outcomes of CRKP BSIs. Patients and Methods: We performed a case-control study of 239 patients with K. pneumoniae BSIs who were treated at Henan Provincial People's Hospital between July 2017 and July 2018. The cases (n=98, 41%) had CRKP BSIs, and the controls (n=141, 59%) had non-carbapenem-resistant K. pneumoniae (non-CRKP) BSIs. Antimicrobial sensitivity was determined using automated broth microdilution and an agar disk diffusion method. Data were obtained from clinical and laboratory records. Multivariate logistic regression and Pearson chi-square tests were used to identify clinical factors and outcomes associated with carbapenem resistance. Results: Risk factors for carbapenem resistance included recent carbapenem use (odds ratio [OR]: 9.98, 95% confidence interval [CI]: 5.2-17.1, P<0.001), invasive procedures (OR: 11.1, 95% CI: 3.3-37.7, P<0.001), and pre-existing diseases of the digestive system (OR: 8.22, 95% CI: 1.73-39.2, P=0.008). Treatment failure was more frequent in the cases (84.7%) than in the controls (32.6%). Conclusion: Exposure to antibiotics, especially carbapenems, and invasive procedures were the major risk factors for carbapenem resistance among patients with K. pneumoniae BSIs. Strict control measures should be implemented to prevent the emergence and spread of CRKP.

A Novel Nomogram for Predicting Risk Factors and Outcomes in Bloodstream Infections Caused by Klebsiella pneumoniae

“…In addition, it could be further optimized in the initial design of the study grouping, replacing the survivors/non-survivors with the treatment success/treatment failure. The corresponding groupings were well defined in the study of Youhua Yuan et al 25 …”

Carbapenems consumption and Klebsiella resistance in intensive care units in Egypt: A study to evaluate the effect of an antimicrobial stewardship program

“…Horikoshi et al showed a positive correlation between days on carbapenems and carbapenems resistance in the pediatric population (Horikoshi et al, 2017). Another case–control study involving Klebsiella pneumoniae bloodstream infection found that carbapenem use caused 9.98-fold increase in the odds of acquiring carbapenem resistance (Yuan et al, 2020). Carbapenem exposure within 1 month before the onset of bloodstream infection was found by other authors to be the only risk factor for developing CRK infection (Liu et al, 2019).…”

Phenotypic and Genotypic Evaluation of Carbapenamase Producing Klebsiella Pneumoniae Isolates with Their Phylogenetic Analysis at an Egyptian University Hospital

“…Similar findings have been noted in a study where diabetes was associated in 30.6% of patients and was not a significant associated risk factors for CRKP (p value = 0.89) whereas invasive procedure as catheter was proved to be associated with CRKP (p value was 0.001). 15 Assessing resistance to ertapenem, it was a sensitive screening test for detecting carbapenem resistance. 12 Nevertheless, resistance to this carbapenem is not a direct indicator for the production of carbapenemases.…”