Insights into multidrug-resistant K. pneumoniae urinary tract infections: From susceptibility to mortality

The incidence of urinary tract infections (UTIs) caused by Klebsiella pneumoniae has exhibited an increasing trend and has become a high burden for many public health systems, especially in hospital settings. Multidrug resistance associated with the production of extended-spectrum β-lactamases (ESBL) among K. pneumoniae isolates is endemic in Southeastern Europe. We retrospectively analyzed 75 cases admitted to 'St. Parascheva' Clinical Hospital of Infectious Diseases in Iasi, Romania, during the first 6 months of 2019 (January 1 to June 30), who had a confirmed diagnosis of K. pneumoniae UTI at discharge. From a total of 75 patients, 34 (45.3%) presented ESBL⁺ K. pneumoniae. The mean age was 66 years (70.1 for the ESBL⁺ patients vs. 62.6 for the ESBL^- patients, P=0.0365). There was a symmetrical sex distribution (37 men vs. 38 women). Of these, 22 men had ESBL⁺ K. pneumoniae UTIs, compared to only 15 with an ESBL^- strain, P=0.0087. Another risk factor for ESBL⁺ K. pneumoniae UTIs was the presence of hospitalization in the past 6 months; 20 (58.82%) patients with ESBL⁺ infections were previously hospitalized, compared to only 5 (12.19%) patients with ESBL^- strains, P<0.0001. The urinary catheter carriers presented an increased prevalence of ESBL⁺ infections (15/34 vs. 5/41, P=0.0012). Regarding mortality, ESBL⁺ infections caused 6 fatalities, compared to only 1 death in the ESBL^- group, P=0.0166. ESBL⁺ K. pneumoniae strains represent an important cause of healthcare-related UTIs, with a significantly higher mortality rate compared to ESBL^- strains. Early identification and adequate management of the risk factors incriminated in ESBL⁺ UTIs should be a priority for physicians in order to limit the dissemination of the ESBL-producing strains and thus to improve the outcome of these patients.