Risk Factors for Carbapenem-resistant Klebsiella pneumoniae Infection and Mortality of Klebsiella pneumoniae Infection

Abstract

Background:Klebsiella pneumoniae (KP) is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP (CRKP) is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP (CSKP) isolates. The aim of the present study was to identify the risk factors for CRKP infection and the predictors of mortality among KP-infected adult patients.Methods:Patients with CRKP and CSKP infection were categorized as the case group and control group, respectively, and we conducted a 1:1 ratio case-control study on these groups. The CRKP isolates collected were tested for antimicrobial susceptibility and presence of KP carbapenemase (KPC) gene. Clinical data were collected to identify risk factors for CRKP infection and mortality of KP infection. Risk factors were analyzed under univariable and multivariable logistic regression model.Results:The independent risk factors for CRKP infection were admission to Intensive Care Unit (odds ratio [OR]: 15.486, 95% confidence interval [CI]: 3.175–75.541, P < 0.001); use of β-lactams and β-lactamase inhibitor combination (OR: 4.765, 95% CI: 1.508–15.055, P = 0.008); use of cephalosporins (OR: 8.033, 95% CI: 1.623–39.763, P = 0.011); fluoroquinolones (OR: 6.090, 95% CI: 1.343–27.613, P = 0.019); and indwelling of urethral catheter (OR: 6.164, 95% CI: 1.847–20.578, P = 0.003). However, older age (OR: 1.079, 95% CI: 1.005–1.158, P = 0.036), Charlson comorbidity index (OR: 4.690, 95% CI: 2.094–10.504, P = 0.000), and aminoglycoside use (OR: 670.252, 95% CI: 6.577–68,307.730, P = 0.006) were identified as independent risk factors for patient deaths with KP infection. The mortality of CRKP group was higher than that of the CSKP group. KPC gene did not play a role in the CRKP group. CRKP mortality was high.Conclusion:Implementation of infection control measures and protection of the immunefunction are crucial.

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

“…21,22 Carbapenem use may cause selective pressure on resistant microorganisms, thereby increasing the risk of infection. Although a few studies have shown that avoiding unnecessary changes in the use of antimicrobials can reduce the incidence of CRKP infections, 23 the results of our study suggest that the use of carbapenems should be minimized. Moreover, the control measures for hospital infection include appropriate and strict isolation precautions, such as hand hygiene of medical staff and isolation of each patient in a separate, walled room, and surgery for only CRKP infection should be implemented to prevent the emergence and spread of CRKP.…”

Gastrointestinal Carriage of Vancomycin-Resistant Enterococci and Carbapenem-Resistant Gram-Negative Bacteria in an Endemic Setting: Prevalence, Risk Factors, and Outcomes

“…Increased total LOS among CRE carriers has been previously described (19,49), as well as the association with increased rate of CRE infections and high mortality (19,20). Previous research has demonstrated that CRE infections are associated more often with sepsis and increased early mortality rate (52), particularly in vulnerable patients such as pediatric, geriatric, immunosuppressed, hospitalized, and chronically ill (53,54).…”

Investigation of carbapenemase and mcr-1 genes in carbapenem-resistant Klebsiella pneumoniae isolates

“…CRKP isolates are more resistant to antibiotics than carbapenem-susceptible KP (CSKP) isolates. Mortality rates are higher in CRKP infections [2].…”