Risk Factors for and Clinical Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Nosocomial Infections: A Retrospective Study in a Tertiary Hospital in Beijing, China

Abstract

Purpose Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections have been increasingly reported worldwide. We aimed to identify the risk factors for nosocomial CRKP infections and assess the clinical outcomes. Patients and Methods We conducted a case-control study with data collected from January 2016 to December 2018 in China. Controls were selected at a ratio of 1:1 from patients with nosocomial carbapenem-susceptible Klebsiella pneumonia (CSKP) infections. Risk factors for nosocomial CRKP infections and clinical outcomes were assessed with univariate and multivariate analyses. Results A total of one hundred forty-two patients with CRKP infections and one hundred forty-two patients with CSKP infections were enrolled in this study. Multivariate analysis showed that exposure to antibiotics within 3 months prior to admission (odds ratio OR, 2.585; 95% confidence interval [CI], 1.425–4.691; P=0.002), exposure to carbapenems (OR, 2.532; 95% CI, 1.376–4.660; P=0.003), exposure to fluoroquinolones (OR, 3.309; 95% CI, 1.326–8.257; P=0.010), and the presence of a nasogastric tube (OR, 2.796; 95% CI, 1.369–5.712; P=0.005) were independent risk factors for CRKP infections. The 30-day mortality rate in the CRKP group was 19.7%, while the in-hospital mortality rate was 28.9%. In the CRKP group, a higher creatinine level (OR, 1.009; 95% CI, 1.002–1.016; P = 0.013), being in shock at the time of a positive culture (OR, 4.454; 95% CI, 1.374–14.443; P = 0.013), and co-infection with other resistant bacteria (OR, 4.799; 95% CI, 1.229–18.740; P = 0.024) were independent predictors of in-hospital mortality in patients with CRKP infections. Kaplan–Meier curves showed that the CRKP group had a shorter survival time than the CSKP group. Conclusion Nosocomial CRKP infection was associated with exposure to carbapenems and fluoroquinolones within 3 months prior to hospitalization and the presence of a nasogastric tube. Patients infected with CRKP had higher 30-day and in-hospital mortality rates. A higher creatinine level, shock and co-infection with other resistant bacteria were independent predictors of in-hospital mortality in patients with CRKP infections.

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

“…Previous studies have demonstrated CRKP patients had shorter survival time than CSKP patients. 14 , 15 Similar to these studies, we also found CRKP was an important risk factor for 30-day mortality rates. The main reason is due to limited antibiotic options for CRKP, resulting in poor prognosis.…”

The burden of carbapenem-resistant Enterobacterales infection in a large Thai tertiary care hospital

“…Clinical features such as requiring MV support, high SOFA score, having septic shock at the onset, and having coinfection with other bacteria were strongly associated with inhospital mortality. Meanwhile, appropriate definitive antimicrobial therapy did not protect against mortality, similar to findings from earlier studies (de Maio Carrilho et al, 2016;Zhang et al, 2021). CRE infection also increased hospital costs, mainly due to the requirement for more intensive medical care and prolonged hospitalization.…”

“…Our CREinfected patients had high APACHE II scores, critical illnesses requiring MV support (62.86%), and required placement of CVC (49.00%) before the onset. Likewise, two other studies concluded that patients infected by carbapenemresistant strains were more likely to have respiratory compromise and unstable hemodynamics requiring MV support and CVC placement than those infected by carbapenem-susceptible strains (Wang et al, 2016;Zhang et al, 2021). The onset of CRE infection varied from a few days to several weeks following hospital admission.…”

“…Other studies have reported that CRE bacteremia was found in only 7%-19% of patients, while pneumonia (41-57%) and urinary tract infection (UTI) (40%) were more common (Wang et al, 2016;Zhang et al, 2018;Zhang et al, 2021). Our subjects were mainly critically ill (40-60%) and required MV support or CVC placement, while the proportion of critically ill patients noted in other studies was only 20-40% (Zhang et al, 2018;Zhang et al, 2021). This likely increased the risk of CRE bacteremia and pneumonia in our study.…”

Risk Factors and Clinical Impact of Carbapenem-Resistant Enterobacterales Coinfections Among Hospitalized Patients with Clostridioides difficile Infection

“…25 Moreover, CRE infections have resulted in substantial morbidity and mortality among hospitalized patients worldwide. [26][27][28] In the era of the increasing incidence of CRE infections, the clinical impact of the coexistence of CRE infections among hospitalized patients with CDI was not clear. The objective of this study is to investigate the risk factors and clinical impact of CRE infections among hospitalized patients with CDI.…”