Risk factors of mortality in bloodstream infections caused by Klebsiella pneumonia

Li, Lanyu; Huang, Huan

doi:10.1097/md.0000000000007924

Cited by 18 publications

(17 citation statements)

References 35 publications

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“…Our single-center, case-control study including 129 patients with K. pneumoniae bacteremia revealed that the 30-day mortality in patients with K. pneumoniae bacteremia was 10.9%, which was lower than that previously reported [2][3][4]. Second, it was suggested that sepsis and iutA are independent predictors of the 30-day mortality of K. pneumoniae bacteremia.…”

Section: Discussioncontrasting

confidence: 56%

“…Particularly, K. pneumoniae bacteremia is a clinically critical presentation associated with high mortality. Previous studies have indicated that mortality was approximately 16%-40% in patients with K. pneumoniae bacteremia [2][3][4]. Therefore, elucidating the predictors associated with mortality in K. pneumoniae bacteremia is critical in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and virulence factors related to the 30-day mortality of Klebsiella pneumoniae bacteremia at a tertiary hospital: a case–control study

Namikawa

Niki

et al. 2019

Eur J Clin Microbiol Infect Dis

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Purpose: Klebsiella pneumoniae bacteremia is a critical clinical presentation that is associated with high mortality. However, extremely few studies have investigated the virulence factors related to mortality of K. pneumoniae bacteremia in patients. The present study elucidated clinical and virulence factors associated with the 30-day mortality of K. pneumoniae bacteremia at a tertiary hospital. Methods: The medical records of 129 patients with K. pneumoniae bacteremia admitted to Osaka City University Hospital between January 2012 and December 2018 were retrospectively reviewed. Patient background characteristics, antimicrobial regimens, and prognosis were evaluated. Additionally, virulence factors were assessed using multiplex polymerase chain reaction to elucidate their association with K. pneumoniae. Results: The 30-day mortality was 10.9% in patients with K. pneumoniae bacteremia. The male-to-female ratio, age, and underlying disease did not differ between the non-survivor and survivor groups. Multivariate analysis showed that sepsis [odds ratio (OR), 7.46; p = 0.005] and iutA (OR, 4.47; p = 0.046) were independent predictors associated with the 30-day mortality of K. pneumoniae bacteremia. Conclusion: Despite the relatively low 30-day mortality of patients with K. pneumoniae bacteremia, the treatment of those with sepsis and those infected with K. pneumoniae harboring iutA may require careful management for improving their outcomes.

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Section: Discussioncontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Clinical and virulence factors related to the 30-day mortality of Klebsiella pneumoniae bacteremia at a tertiary hospital: a case–control study

Namikawa

Niki

et al. 2019

Eur J Clin Microbiol Infect Dis

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“…However, resistance to carbapenems is making the treatment of CR K. pneumoniae extremely difficult. The results of a retrospective study conducted at a Shanghai teaching hospital revealed an overall 30-day mortality rate for BSIs of 25% for patients who had contracted CR K. pneumoniae [31]. Another retrospective cohort study on the effect of appropriate combination therapy on mortality in patients with BSIs caused by carbapenemase-producing Enterobacteriaceae reported that use of combination therapy was associated with improved survival only in patients with a high mortality risk score [32].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance trends in bloodstream infections at a large teaching hospital in China: a 20-year surveillance study (1998-2017)

Tian

Zhang

Sun

2019

Antimicrob Resist Infect Control

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Background Bacterial bloodstream infections (BSIs) cause high morbidity and mortality worldwide in humans, but the pathogenic spectrum varies from region to region. Long-term monitoring of the pathogenic spectrum and changes in bacterial antibiotic resistance is hugely important for effective clinical therapy and infection control. This study examined the data for BSIs in Tongji Hospital, one of the largest teaching hospitals in China, in an attempt to gain better understanding of bacterial antibiotic resistance in China, focusing on central China. Methods Data from Tongji Hospital for a 20-year period (1998–2017) were used for a retrospective analysis to understand the pathogenic spectrum of BSIs and the changes occurring in antimicrobial resistance in central China. The disk diffusion and E test methods were used for antimicrobial susceptibility testing according to Clinical & Laboratory Standards Institute methodologies, and the data were analyzed by WHONET 5.6 software. Results The isolated pathogens mainly came from hospitalized patients not treated in intensive care units (ICUs), and accounted for 81.5% of the total (9130/11200). The most common Gram-negative and Gram-positive bacterial BSI-causing pathogens were Escherichia coli and Staphylococcus aureus , respectively. The detection rate for methicillin-resistant S. aureus (MRSA) in the hospitalized non-ICU patients increased from 8.4% in 1998–2002 to 63% in 2013–2017, while the detection rate for carbapenem-resistant (CR) Klebsiella pneumoniae was below 5% in 1998–2012 but increased to 34.9% in 2013–2017. In contrast, worryingly, the detection rate for CR K. pneumoniae in ICU patients increased from 0% in 2013 to 75% in 2016. E. coli displayed the highest sensitivity rates to imipenem, meropenem and amikacin, all of which were > 90%, followed by cefoxitin at > 80%, and cefoperazone/sulbactam at > 70%. K. pneumoniae isolates were most sensitive to imipenem, meropenem and amikacin antibiotics, with sensitivity rates exceeding 60%. S. aureus isolates were most sensitive to vancomycin, teicoplanin and trimethoprim/sulfamethoxazole, with sensitivity rates exceeding 90%. Conclusions BSIs caused by CR K. pneumoniae clearly posed a severe challenge to infection control and treatment of ICU and non-ICU patients in this retrospective study, while MRSA was an issue for non-ICU patients.

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“…Although KP has had an increasingly important role in infection at various sites (i.e., urinary tract, pulmonary, bloodstream, biliary tract) in recent years, there has been little research on CAUTIs caused by KP (9,11,15,16). To our knowledge, this is the first population-based study of KP-CAUTIs in China.…”

Section: Discussionmentioning

confidence: 95%

Clinical characteristics and risk factors of catheter-associated urinary tract infections caused by Klebsiella Pneumoniae

Sai¹,

Li²,

Zhu³

et al. 2020

Ann Palliat Med

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Background: The clinical characteristics and risk factors of catheter-associated urinary tract infections (CAUTIs) caused by Klebsiella pneumoniae (KP) have not been well investigated. Methods: This retrospective study performed at a university teaching hospital in China from January 2012 to November 2017 analyzed data for 227 patients with urinary tract infection (UTI) caused by KP. Patients' demographic characteristics and clinical outcomes were recorded. Risk factors were analyzed using a binary logistic regression model. Results: Of 227 patients with Klebsiella pneumoniae-related urinary tract Infection (KP-UTI), the infection was catheter-associated in 90 patients. More than half of them were male (60%), over 60 years old, hospitalized in general ward, always acquired in hospital, and got a longer hospitalization more than one month. The Klebsiella pneumoniae-related catheter-associated urinary tract infections (KP-CAUTIs) patients always combined with lots of chronic comorbidities. A high proportion of invasive device, extendedspectrum β-lactamase (ESBL) expression and multidrug resistance (MDR) were found in KP-CAUTIs patients. When taken antimicrobial activity into consideration, KP-CAUTIs patients performed resistance to most antibiotics in varying degrees. Logistic regression analysis revealed that after grouping by ESBL expression and in-hospital mortality among patients with KP-CAUTI, complicated urinary tract infection (cUTI) was an independent risk factor for ESBL positive KP-CAUTIs [odds ratio (OR) 59.256; 95% CI, 3.417-1,027.628; P=0.005], whereas congestive heart failure was identified as an independent risk factor for in-hospital mortality (OR 25.592; 95% CI, 2.376-275.629; P=0.008) in KP-CAUTI patients. Conclusions: Patients with KP-CAUTI displayed distinctive characteristics. cUTI and congestive heart failure were independently associated with ESBL expression and in-hospital mortality in patients with KP-CAUTI.

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Risk factors of mortality in bloodstream infections caused by Klebsiella pneumonia

Cited by 18 publications

References 35 publications

Clinical and virulence factors related to the 30-day mortality of Klebsiella pneumoniae bacteremia at a tertiary hospital: a case–control study

Clinical and virulence factors related to the 30-day mortality of Klebsiella pneumoniae bacteremia at a tertiary hospital: a case–control study

Antimicrobial resistance trends in bloodstream infections at a large teaching hospital in China: a 20-year surveillance study (1998-2017)

Clinical characteristics and risk factors of catheter-associated urinary tract infections caused by Klebsiella Pneumoniae

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