State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
J Infect Dis. 2020 Mar 16;221(Suppl 2):S174-S183. doi: 10.1093/infdis/jiz559.
Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a major problem among nosocomial infections, and it is a serious threat to patients. The clinical characteristics and outcome of CRKP bloodstream infection (BSI) in nontransplant patients remains unelucidated. The aim of this study was as follows: identify the risk factors of CRKP infection; generate new ideas for prevention; and generate new ideas for the most effective therapeutic management in nontransplant patients.
The study retrospectively analyzed the clinical and microbiological data of nontransplant patients with K pneumoniae (KP) bacteremia from January 2013 to December 2015 to identify risk factors, clinical features, and outcomes using multivariate logistic regression analysis.
Of the 371 patients with KP-BSI in nontransplant patients included in this study, 28.0% (N = 104) had CRKP. The 28-day mortality was higher in patients infected with CRKP (55.8%) than in those with carbapenem-susceptible KP (13.9%) (P < .001). Multivariate analysis showed previous gastric catheterization, previous use of carbapenems, hypoproteinemia, and high Acute Physiologic Assessment and Chronic Health Evaluation II scores as independent risk factors for CRKP-BSIs. Carbapenem-resistant KP infection, severe illness, and tigecycline therapy were independent risk factors for death from KP-BSIs. Taken together, inappropriate antibiotic treatment both in empirical and definitive therapy and imipenem minimum inhibitory concentrations (MICs) of >8 mg/L were associated with poor clinical outcome.
Nontransplant patients with CRKP-BSI had higher mortality. Carbapenems exposure was an independent risk factor for CRKP infection. Imipenem MICs of >8 mg/L, tigecycline therapy, and inappropriate treatments increased the 28-day mortality of KP-BSI patients.
耐碳青霉烯类肺炎克雷伯菌（CRKP）已成为医院感染的主要问题，对患者构成严重威胁。非移植患者耐碳青霉烯类肺炎克雷伯菌血流感染（BSI）的临床特征和结局尚不清楚。本研究旨在确定 CRKP 感染的危险因素；为预防提供新思路；为非移植患者提供最有效的治疗管理思路。
本研究回顾性分析了 2013 年 1 月至 2015 年 12 月非移植患者中肺炎克雷伯菌菌血症的临床和微生物学数据，采用多变量 logistic 回归分析确定危险因素、临床特征和结局。
在本研究纳入的 371 例非移植患者中，28.0%（N=104）为耐碳青霉烯类肺炎克雷伯菌。耐碳青霉烯类肺炎克雷伯菌感染患者 28 天死亡率（55.8%）高于碳青霉烯类敏感肺炎克雷伯菌感染患者（13.9%）（P<0.001）。多变量分析显示，既往胃管置管、既往使用碳青霉烯类、低蛋白血症和急性生理和慢性健康评估 II 评分高是耐碳青霉烯类肺炎克雷伯菌血流感染的独立危险因素。耐碳青霉烯类肺炎克雷伯菌感染、病情严重和替加环素治疗是肺炎克雷伯菌血流感染死亡的独立危险因素。总的来说，经验性和确定性治疗中不适当的抗生素治疗以及亚胺培南最低抑菌浓度（MIC）>8mg/L 与不良临床结局相关。
非移植患者耐碳青霉烯类肺炎克雷伯菌血流感染死亡率较高。碳青霉烯类药物暴露是耐碳青霉烯类肺炎克雷伯菌感染的独立危险因素。亚胺培南 MIC 值>8mg/L、替加环素治疗和不适当的治疗增加了肺炎克雷伯菌血流感染患者 28 天死亡率。
