Clinical Characteristics, Risk Factors, and Outcomes of Patients with Polymicrobial Klebsiella pneumoniae Bloodstream Infections

Abstract

Background. Polymicrobial Klebsiella pneumoniae bloodstream infection (KP-BSI) has been reported to account for more than 10% of all KP-BSI, but few studies have characterized polymicrobial KP-BSI. Our study investigated the clinical characteristics, risk factors, and outcomes of polymicrobial KP-BSI by comparing with monomicrobial KP-BSI. Methods. We conducted a single-center retrospective cohort study of patients with KP-BSI from 1 January 2013 to 31 December 2018 and collected the clinical data by reviewing electronic medical records. Results. Of the 818 patients with KP-BSI recruited, 13.9% (114/818) were polymicrobial KP-BSI. The severity of illness in polymicrobial and monomicrobial KP-BSI was similar, while the rate of resistance to carbapenems was obviously higher in polymicrobial KP-BSI (78.1% vs. 65.6%, p = 0.009 ). On multivariate analysis, hospitalization in burn ward (odds ratio (OR) 6.13, 95% confidence interval (CI) 2.00-18.76, p = 0.001 ) and intensive care unit (OR 2.39, 95% CI 1.05-5.43, p = 0.038 ) was independently associated with polymicrobial KP-BSI. Gram-negative bacteria accounted for the highest proportion (68.9%) among copathogens of polymicrobial KP-BSI, whereas gram-positive bacteria (22.9%) and Candida (8.2%) ranked the second and the third, respectively, with Acinetobacter baumannii being the most common (23.0%). Patients with polymicrobial KP-BSI had longer hospital days after BSI onset and total hospital days than patients with monomicrobial KP-BSI (median (interquartile range (IQR)), 19 (5, 39) vs. 12 (6, 25), 37 (21, 67) vs. 29 (16, 53), respectively, p < 0.05 ). The mortality did not differ between polymicrobial KP-BSI and monomicrobial KP-BSI (all p > 0.05 ). Conclusions. It was observed that polymicrobial KP-BSI accounted for a significant proportion among all KP-BSI in the current study. Hospitalization in burn ward and intensive care unit was an independent risk factor for the development of polymicrobial KP-BSI. The patients with polymicrobial KP-BSI had a higher rate of carbapenem-resistant K. pneumoniae and might have poor outcomes compared to monomicrobial KP-BSI.

Multidrug-Resistant Acinetobacter baumannii May Cause Patients to Develop Polymicrobial Bloodstream Infection

“…us theoretically, mortality of polymicrobial AB-BSI should at least be similar to that of monomicrobial AB-BSI or higher. However, we did not find any difference in mortality between polymicrobial BSI and monomicrobial BSI in those reports which focused on specific pathogens BSI [9][10][11][12]. For this reason, whether the clinical characteristics of polymicrobial AB-BSI are similar to those described in the abovementioned studies, whether multidrugresistant bacteria lead to polymicrobial AB-BSI, whether there are differences in mortality and drug resistance rates between groups of polymicrobial AB-BSI and monomicrobial AB-BSI, and factors that are associated with polymicrobial AB-BSI are still unclear.…”

“…Most BSIs are monomicrobial, but in recent years, the trend of polymicrobial BSI has been rising, accounting for about 6-34% of BSIs [7,8]. ere have been several reports on polymicrobial BSI with specific pathogens [9][10][11][12], while polymicrobial AB-BSI has not received much attention at present. Studies have shown that A. baumannii was associated with higher mortality in intensive care patients with bacteremia [13].…”

Molecular Methodologies for Improved Polymicrobial Sepsis Diagnosis

“…Immunosuppression resulting from surgery, burn injuries or febrile neutropenia have been recognised as significant risk factors for developing polymicrobial sepsis [15,26,27]. Additional risk factors that have been identified are listed in Table 2.…”

“…Additional risk factors that have been identified are listed in Table 2. [26] 6.1 ICU hospitalisation [26] 2.4 Abdominal infections [15] 2.2-2.9 Corticosteroid therapy [15] 1.5…”

Bacteriological Profile and Antimicrobial Susceptibility Patterns of Gram-Negative Bloodstream Infection and Risk Factors Associated with Mortality and Drug Resistance: A Retrospective Study from Shanxi, China

“…However, the bacterial distribution and the drug-resistant spectrum of GNBSI vary from place to place. 17 The mortality risk factors of patients with GNBSI are dynamic as well. 18 The experience of other countries or regions may be of little guide to this region.…”