Itani Rania, Khojah Hani M J, Raychouni Hamza, Kibrit Rahaf, Shuhaiber Patricia, Dib Carole, Hassan Mariam, Mukattash Tareq L, El-Lakany Abdalla
Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon.
Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia.
BMC Infect Dis. 2025 Apr 28;25(1):620. doi: 10.1186/s12879-025-11010-5.
Klebsiella pneumoniae is a significant cause of both community-acquired and nosocomial infections, leading to high morbidity and mortality rates. The increasing antimicrobial resistance among K. pneumoniae strains poses a critical challenge to effective treatment. This study aimed to assess the appropriateness of initial antimicrobial therapy, determine the 30-day all-cause mortality rate, and identify predictors of mortality among patients infected with K. pneumoniae in Lebanese hospitals.
A multicenter retrospective observational study was conducted across three university hospitals in Beirut, Lebanon. The study included hospitalized adult patients with confirmed K. pneumoniae infections. Kaplan-Meier survival analysis and log-rank tests were used to analyze time-to-mortality. Binary logistic regression was performed to identify predictors of mortality.
Of 2,655 cases screened, 410 patients were enrolled, and 395 cases were included in the final analysis of the 30-day mortality after excluding those lost to follow-up. Nearly one-third of the isolates (36.8%) were extended-spectrum β-lactamase (ESBL)-producing, while 6.8% were carbapenem-resistant K. pneumoniae (CRKP). The most commonly prescribed empirical antibiotics were meropenem (31.7%), amikacin (28.5%), and ceftriaxone (22.2%). Around one-third of the patients (32.9%) received inappropriate initial antimicrobial therapy. The 30-day mortality rate was 14.4%. Main predictors significantly associated with mortality in patients with K. pneumoniae infection were solid cancer (adjusted odds ratio [AOR] = 7.82, P < 0.01), coronary artery disease (AOR = 4.81, P = 0.01), age ≥ 65 years (AOR = 4.22, P = 0.02), type II diabetes mellitus (AOR = 3.96, P = 0.01), receiving inappropriate initial antimicrobial therapy (AOR = 2.96, P = 0.02), infection with CRKP isolates (AOR = 2.53, P = 0.03), and having a higher Charlson comorbidity index (AOR = 1.61, P = 0.001).
The study highlights the critical need for effective antimicrobial stewardship and tailored infection control protocols to mitigate the high resistance rates and improve patient outcomes in Lebanon. Emphasis should be placed on enhancing the monitoring of local resistance patterns and using these data to guide the selection of appropriate empirical therapy to reduce mortality associated with K. pneumoniae infections.
肺炎克雷伯菌是社区获得性感染和医院感染的重要病因，导致高发病率和死亡率。肺炎克雷伯菌菌株中日益增加的抗菌药物耐药性对有效治疗构成了严峻挑战。本研究旨在评估初始抗菌治疗的适宜性，确定30天全因死亡率，并识别黎巴嫩医院中肺炎克雷伯菌感染患者的死亡预测因素。
在黎巴嫩贝鲁特的三家大学医院进行了一项多中心回顾性观察研究。该研究纳入了确诊为肺炎克雷伯菌感染的住院成年患者。采用Kaplan-Meier生存分析和对数秩检验分析死亡时间。进行二元逻辑回归以识别死亡预测因素。
在筛查的2655例病例中，410例患者入组，在排除失访患者后，395例病例纳入30天死亡率的最终分析。近三分之一的分离株（36.8%）产超广谱β-内酰胺酶（ESBL），而6.8%为耐碳青霉烯类肺炎克雷伯菌（CRKP）。最常用的经验性抗生素是美罗培南（31.7%）、阿米卡星（28.5%）和头孢曲松（22.2%）。约三分之一的患者（32.9%）接受了不适当的初始抗菌治疗。30天死亡率为14.4%。与肺炎克雷伯菌感染患者死亡率显著相关的主要预测因素为实体癌（调整比值比[AOR]=7.82，P<0.01）、冠状动脉疾病（AOR=4.81，P=0.01）、年龄≥65岁（AOR=4.22，P=0.02）、II型糖尿病（AOR=3.96，P=0.01）、接受不适当的初始抗菌治疗（AOR=2.96，P=0.02）、感染CRKP分离株（AOR=2.53，P=0.03）以及Charlson合并症指数较高（AOR=1.61，P=0.001）。
该研究强调了有效抗菌药物管理和量身定制的感染控制方案对于减轻黎巴嫩高耐药率和改善患者结局的迫切需求。应重点加强对当地耐药模式的监测，并利用这些数据指导选择合适的经验性治疗，以降低与肺炎克雷伯菌感染相关的死亡率。
