Epidemiology, Drug Resistance, and Risk Factors for Mortality Among Hematopoietic Stem Cell Transplantation Recipients with Hospital-Acquired Klebsiella pneumoniae Infections: A Single-Center Retrospective Study from China

Abstract

Objective Infection is the most common complication and cause of death after hematopoietic stem cell transplantation (HSCT). Our study aims to investigate the clinical characteristics and risk factors for death of Klebsiella pneumoniae infections in HSCT recipients, so as to provide evidence for guiding antibiotic use and improving prognosis in the future. Methods The epidemiology, clinical manifestations and drug resistance rate with K. pneumoniae infections among HSCT recipients between January 1, 2012 and September 30, 2021 were retrospectively reviewed. Logistic regression model and Cox regression model were respectively used to determine the risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) acquisition and death. Results Fifty-nine HSCT recipients suffered from K. pneumoniae infections, with a mortality rate of 42.4%. The most common site was lung, followed by blood stream. The resistance rate of K. pneumoniae to various clinically common antibiotics was high, especially CRKP, which was only sensitive to amikacin and tigecycline. Independent risk factor for CPKP acquisition was a previous infection within 3 months before transplantation (OR=10.981, 95% CI 1.474–81.809, P =0.019). Independent risk factors for mortality included interval from diagnosis to transplantation > 180 days (HR=3.963, 95% CI 1.25–12.561, P =0.019), engraftment period > 20 days (HR=8.015, 95% CI 2.355–27.279, P =0.001), non-use of anti-CMV immunoglobulin/rituximab after transplantation (HR=10.720, 95% CI 2.390–48.089, P =0.002), and PCT > 5 μg/L (HR=5.906, 95% CI 1.623–21.500, P =0.007). Conclusion K. pneumoniae infection has become a serious threat for HSCT recipients, which reminds us to pay enough attention and actively seek new strategies.

Epidemiology, antimicrobial resistance, and mortality risk factors of carbapenem resistant gram-negative bacteria in hematopoietic stem cell transplantation recipients

“…Further multivariate analysis revealed that the interval from diagnosis to transplantation > 180 days, septic shock, low platelet count and high bilirubin level at the initial stage of infection were independent risk factors for death. In previous reports, we have described the adverse effects of extended transplant interval: persistent disease state, multiple chemotherapy treatments, low immunity, poor body function, delayed donor cells implantation, etc (Liu et al, 2022). This is why both domestic and international guidelines unanimously recommend early transplantation for eligible patients (Blackburn et al, 2019).…”

“…Bacterial infection was defined as the occurrence of inflammatory reaction symptoms in the patient and the isolation of pathogenic microorganisms from blood or other normally sterile sites and exclusion of contamination and colonization (Horan et al, 2018). Infections occurred 48 hours after admission were considered hospital-acquired (Liu et al, 2022). Inappropriate empiric antimicrobial therapy was defined as the absence of microbial-sensitive antibiotics within 48 hours of specimen acquisition (Wan et al, 2017).…”

Clinical characteristics and mortality risk factors of mixed bacterial infections in hematopoietic stem cell transplantation recipients

“…In previous reports, we have repeatedly emphasized the disadvantages of prolonged transplantation interval: disease recurrence, repeated chemotherapy, bone marrow suppression, immunosuppression, mucosal damage, impaired organ function, excessive psychological pressure, delayed donor cell implantation, etc. ( Liu et al., 2022 ; Jia et al., 2023 ). Kikuchi M et al.…”