Wu Juan, Xie Zhiqiang, Li Xueyu, Du Kaili, Liao Zhongxian, Shi Yawei, Abudumaijiti Munire, Chen Jiadi, Cao Yingping, Fu Xinmiao
College of Life Sciences, Fujian Normal University, Fuzhou City, 350117, PR China.
Department of Laboratory Medicine, School of Medical Technology and Engineering, Fujian Medical University, Fuzhou City, 350004, PR China.
BMC Microbiol. 2025 Jul 2;25(1):394. doi: 10.1186/s12866-025-04111-3.
Bloodstream infections (BSIs) caused by Klebsiella pneumoniae (K. pneumoniae) are a serious risk for patients with acute leukemia (AL), especially in the context of the increasing global prevalence of antibiotic-resistant strains. This retrospective study aimed to explore the risk factors for and outcomes of BSIs caused by antibiotic-resistant K. pneumoniae strains among AL patients.
This retrospective cohort study included patients with AL who suffered from K. pneumoniae BSIs from January 2017 to March 2024. Multivariate cox proportional hazards regression models were constructed to identify independent predictors of mortality. A Kaplan-Meier curve was used to evaluate the clinical outcomes of AL patients.
The study included 122 AL patients with K. pneumoniae BSIs. Multivariate analysis revealed that the previous use of quinolone, cephalosporin or aminoglycoside was an independent risk factor for carbapenem-resistant (CR) K. pneumoniae BSIs. Similarly, previous use of carbapenem or cephalosporin and hospitalization duration were independent risk factors for extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae BSIs. Furthermore, the previous use of corticosteroids could prevent the development of CR K. pneumoniae BSIs and ESBL-K. pneumoniae BSIs. Previous treatment with quinolones, cephalosporins, and aminoglycosides independently contributed to the risk of multidrug-resistant (MDR)-K. pneumoniae BSIs. The 30-day mortality rate among these AL patients was 23.77%. The 30-day mortality rates for AL patients with MDR-K. pneumoniae BSIs and non-MDR-K. pneumoniae BSIs were 42.5% and 13.79%, respectively. Similarly, the CR of K. pneumoniae and ESBL-producing K. pneumoniae also increased the 30-day mortality rate among AL patients with K. pneumoniae BSIs. Multivariate analysis revealed that MDR-K. pneumoniae BSIs and age ≥ 55 years were independent risk factors for 30-day mortality.
Previous antibiotic exposure is a key risk factor for the development of antibiotic-resistant K. pneumoniae BSIs among AL patients. MDR K. pneumoniae BSIs and age older than 55 years were independent risk factors for 30-day mortality among AL patients with K. pneumoniae BSIs.
肺炎克雷伯菌（K. pneumoniae）引起的血流感染（BSIs）对急性白血病（AL）患者构成严重风险，尤其是在全球抗生素耐药菌株患病率不断上升的背景下。这项回顾性研究旨在探讨AL患者中耐抗生素肺炎克雷伯菌菌株引起的血流感染的危险因素和结局。
这项回顾性队列研究纳入了2017年1月至2024年3月期间患有肺炎克雷伯菌血流感染的AL患者。构建多变量cox比例风险回归模型以确定死亡率的独立预测因素。采用Kaplan-Meier曲线评估AL患者的临床结局。
该研究纳入了122例患有肺炎克雷伯菌血流感染的AL患者。多变量分析显示，先前使用喹诺酮类、头孢菌素类或氨基糖苷类药物是耐碳青霉烯类（CR）肺炎克雷伯菌血流感染的独立危险因素。同样，先前使用碳青霉烯类或头孢菌素类药物以及住院时间是产超广谱β-内酰胺酶（ESBL）肺炎克雷伯菌血流感染的独立危险因素。此外，先前使用糖皮质激素可预防CR肺炎克雷伯菌血流感染和ESBL肺炎克雷伯菌血流感染的发生。先前使用喹诺酮类、头孢菌素类和氨基糖苷类药物独立增加了多重耐药（MDR）肺炎克雷伯菌血流感染的风险。这些AL患者的30天死亡率为23.77%。MDR肺炎克雷伯菌血流感染和非MDR肺炎克雷伯菌血流感染的AL患者的30天死亡率分别为42.5%和13.79%。同样，肺炎克雷伯菌的CR和产ESBL肺炎克雷伯菌也增加了患有肺炎克雷伯菌血流感染的AL患者的30天死亡率。多变量分析显示，MDR肺炎克雷伯菌血流感染和年龄≥55岁是30天死亡率的独立危险因素。
先前的抗生素暴露是AL患者中耐抗生素肺炎克雷伯菌血流感染发生的关键危险因素。MDR肺炎克雷伯菌血流感染和年龄大于55岁是患有肺炎克雷伯菌血流感染的AL患者30天死亡率的独立危险因素。
