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Clinical Characteristics and Independent Risk Factors for Multidrug-Resistant Klebsiella pneumoniae Bloodstream
Panpan Xu1, Yifeng Mao1, Qingqing Chen2,3
1Department of Critical Care Medicine, Taizhou Municipal Hospital (Taizhou University Affiliated Municipal Hospital), School of Medicine, Taizhou University, Taizhou, Zhejiang, 318000, People's Republic of China.
Purpose:
This study aimed to analyze the clinical characteristics and risk factors of multidrug-resistant Klebsiella pneumoniae bloodstream infections (MDR KP-BSI) compared to non-MDR KP-BSI among adult patients in China, providing guidance for clinicians to prevent MDR KP-BSI.
Patients And Methods:
A retrospective analysis of 240 adult patients with KP-BSI (2019-2023) was conducted. Clinical data were analyzed using multivariable logistic regression to identify risk factors.
Results:
MDR KP-BSI prevalence was 22.5% (54/240). The MDR KP-BSI group had higher rates of comorbidities (hemiplegia, COPD/severe asthma, chronic cardiac insufficiency, cerebrovascular accident) and higher disease severity scores (APACHE II, SOFA, Pitt bacteremia, Charlson index, all P<0.05). Treatment-related factors (antibiotic exposure, ICU admission, nutrition support, invasive procedures) were more frequent in the MDR KP-BSI group (P<0.05). Pulmonary origin was significantly more common (42.6% vs 12.4%, P<0.05), while liver origin was less common (1.9% vs 24.2%, P<0.05) in MDR versus non-MDR KP-BSI. MDR KP-BSI patients had significantly worse outcomes: higher 7-day (40.7% vs 11.8%, P<0.001), 14-day (35.2% vs 10.8%, P<0.001), and 28-day mortality (27.8% vs 8.6%, P<0.001), and prolonged hospitalization [26.5 days (14.0, 64.5) vs 13.0 days (8.0, 23.0), P<0.001]. Multivariable analysis identified independent risk factors: recent antibiotic exposure (adjusted OR [aOR] 7.025; 95% CI 2.695-18.313), cerebrovascular accident history (aOR 3.095; 95% CI 1.054-9.903), and pulmonary infection source (aOR 2.941; 95% CI 1.101-7.895).
Conclusion:
These predictors emphasize the need for antibiotic stewardship, infection control, and early interventions in high-risk patients to reduce MDR KP-BSI incidence.
Insights
Multidrug-resistant Klebsiella pneumoniae bloodstream infections (MDR KP-BSI) are linked to comorbidities, pulmonary sources, and recent antibiotic exposure. Early interventions and antibiotic stewardship are crucial for high-risk patients.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Klebsiella pneumoniae bloodstream infections (KP-BSI) pose a significant threat.
- The rise of multidrug-resistant (MDR) strains complicates treatment and increases mortality.
- Understanding the specific risk factors for MDR KP-BSI is crucial for effective prevention and management.
Purpose of the Study:
- To analyze the clinical characteristics of multidrug-resistant Klebsiella pneumoniae bloodstream infections (MDR KP-BSI) in adult patients.
- To identify and compare risk factors associated with MDR KP-BSI versus non-MDR KP-BSI.
- To provide clinical guidance for the prevention of MDR KP-BSI.
Main Methods:
- Retrospective analysis of 240 adult patients with KP-BSI from 2019-2023.
- Clinical data were collected and analyzed.
- Multivariable logistic regression was employed to identify independent risk factors for MDR KP-BSI.
Main Results:
- MDR KP-BSI prevalence was 22.5%.
- MDR KP-BSI patients exhibited higher rates of comorbidities (e.g., cerebrovascular accident), disease severity scores, and treatment-related factors (e.g., recent antibiotic exposure, ICU admission).
- Pulmonary infection source was more common in MDR KP-BSI, associated with significantly higher mortality and prolonged hospitalization. Independent risk factors identified were recent antibiotic exposure, cerebrovascular accident history, and pulmonary infection source.
Conclusions:
- Recent antibiotic exposure, cerebrovascular accident history, and pulmonary infection source are significant independent risk factors for MDR KP-BSI.
- These findings highlight the importance of robust antibiotic stewardship programs.
- Enhanced infection control measures and early interventions in high-risk patient populations are essential to reduce the incidence of MDR KP-BSI.
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