Bhat Divya, Rajan Asha K, Aditya Vankadari, Eshwara Vandana Kalwaje, Varma Muralidhar, Umakanth Shashikiran, Thunga Girish, Shanbhag Vishal
Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India.
Acta Trop. 2025 Sep;269:107744. doi: 10.1016/j.actatropica.2025.107744. Epub 2025 Jul 14.
Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a critical pathogen associated with high mortality in bloodstream infections, particularly in regions with high antimicrobial resistance. Aim of this study was to identify antimicrobial resistance patterns, clinical outcomes, and independent risk factors for mortality among patients with K. pneumoniae bacteraemia (KPB), comparing CRKP and carbapenem sensitive K. pneumoniae (CSKP) infections.
A retrospective observational study was conducted among adult ICU patients diagnosed with KPB between January to December 2023. Demographics, comorbidities, laboratory markers, treatment details, and clinical outcomes were matched between CRKP and CSKP groups. Univariate and multivariate logistic regression were used to identify independent predictors of mortality. Kaplan-Meier analysis was used to assess survival differences. All the analyses were performed using SPSS vs 20.0 software.
Among 116 patients, 55.2 % had CRKP bacteraemia. CRKP patients had old age (>65 years) and had higher rates of comorbidities including chronic liver (26.5 %) and kidney disease (15.6 %). Overall mortality rate was higher in CRKP patients (57.8 %). Seven factors were independently associated with mortality: old age [OR:1.402(1.097-2.005)], chronic liver disease [OR:1.21(1.039-3.12)], chronic kidney disease [OR:2.30(1.277-6.098)]), prior carbapenem resistance [OR:1.369(1.037-3.66)], elevated CRP [OR:2.002(1.097-3.06)], vasopressor use within 48 h [OR:1.332(1.007-2.148)] and early septic shock [OR:1.99(1.071-5.649)]. Kaplan-Meier survival curves showed higher early mortality in CRKP patients, suggesting that they died even before a conventional culture report was available.
Patients with CRKP bacteraemia showed significantly higher clinical severity and early mortality compared to those with CSKP infections. Rapid diagnostics, early appropriate empirical therapy in high-risk patients of CRKP and integrated stewardship strategies are critical for better outcomes. These findings offer actionable insights for risk stratification, diagnostic stewardship and timely intervention in high-burden settings.
耐碳青霉烯类肺炎克雷伯菌（CRKP）已成为血流感染中与高死亡率相关的关键病原体，尤其是在抗菌药物耐药性高的地区。本研究的目的是比较CRKP感染和碳青霉烯类敏感肺炎克雷伯菌（CSKP）感染患者的抗菌药物耐药模式、临床结局及死亡的独立危险因素。
对2023年1月至12月期间诊断为肺炎克雷伯菌血流感染（KPB）的成年ICU患者进行回顾性观察研究。对CRKP组和CSKP组的人口统计学、合并症、实验室指标、治疗细节及临床结局进行匹配。采用单因素和多因素逻辑回归分析确定死亡的独立预测因素。采用Kaplan-Meier分析评估生存差异。所有分析均使用SPSS 20.0软件进行。
116例患者中，55.2%为CRKP血流感染。CRKP患者年龄较大（>65岁），合并症发生率较高，包括慢性肝病（26.5%）和肾病（15.6%）。CRKP患者的总体死亡率较高（57.8%）。七个因素与死亡率独立相关：高龄[比值比（OR）：1.402（1.097 - 2.005）]、慢性肝病[OR：1.21（1.039 - 3.12）]、慢性肾病[OR：2.30（1.277 - 6.098）]、既往碳青霉烯类耐药[OR：1.369（1.037 - 3.66）]、C反应蛋白（CRP）升高[OR：2.002（1.097 - 3.06）]、48小时内使用血管活性药物[OR：1.332（1.007 - 2.148）]和早期感染性休克[OR：1.99（1.071 - 5.649）]。Kaplan-Meier生存曲线显示CRKP患者早期死亡率较高，这表明他们甚至在常规培养报告出来之前就已死亡。
与CSKP感染患者相比，CRKP血流感染患者的临床严重程度和早期死亡率显著更高。快速诊断、对CRKP高危患者进行早期适当的经验性治疗以及综合管理策略对于改善结局至关重要。这些发现为高负担环境下的风险分层、诊断管理和及时干预提供了可采取行动的见解。
