Risk Factors for and Clinical Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Nosocomial Infections: A Retrospective Study in a Tertiary Hospital in Beijing, China

Huijuan Zhang; Zhe Guo; Yan Chai; Yi-Peng Fang; Xiangdong Mu; Nan Xiao; Jun Guo; Zhong Wang

doi:10.2147/IDR.S298530

Risk Factors for and Clinical Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Nosocomial Infections: A Retrospective Study in a Tertiary Hospital in Beijing, China

Infect Drug Resist. 2021 Apr 13:14:1393-1401. doi: 10.2147/IDR.S298530. eCollection 2021.

Authors

Huijuan Zhang^{1

2}, Zhe Guo^{1

3}, Yan Chai¹, Yi-Peng Fang¹, Xiangdong Mu^{1

2}, Nan Xiao⁴, Jun Guo^{1

2}, Zhong Wang^{1

5}

Affiliations

¹ School of Clinical Medicine, Tsinghua University, Beijing, 100084, People's Republic of China.
² Department of Pulmonary and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China.
³ Department of Liver Intensive Care Unit, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China.
⁴ Department of Laboratory Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China.
⁵ Department of General Practice Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People's Republic of China.

Abstract

Purpose: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections have been increasingly reported worldwide. We aimed to identify the risk factors for nosocomial CRKP infections and assess the clinical outcomes.

Patients and methods: We conducted a case-control study with data collected from January 2016 to December 2018 in China. Controls were selected at a ratio of 1:1 from patients with nosocomial carbapenem-susceptible Klebsiella pneumonia (CSKP) infections. Risk factors for nosocomial CRKP infections and clinical outcomes were assessed with univariate and multivariate analyses.

Results: A total of one hundred forty-two patients with CRKP infections and one hundred forty-two patients with CSKP infections were enrolled in this study. Multivariate analysis showed that exposure to antibiotics within 3 months prior to admission (odds ratio OR, 2.585; 95% confidence interval [CI], 1.425-4.691; P=0.002), exposure to carbapenems (OR, 2.532; 95% CI, 1.376-4.660; P=0.003), exposure to ﬂuoroquinolones (OR, 3.309; 95% CI, 1.326-8.257; P=0.010), and the presence of a nasogastric tube (OR, 2.796; 95% CI, 1.369-5.712; P=0.005) were independent risk factors for CRKP infections. The 30-day mortality rate in the CRKP group was 19.7%, while the in-hospital mortality rate was 28.9%. In the CRKP group, a higher creatinine level (OR, 1.009; 95% CI, 1.002-1.016; P = 0.013), being in shock at the time of a positive culture (OR, 4.454; 95% CI, 1.374-14.443; P = 0.013), and co-infection with other resistant bacteria (OR, 4.799; 95% CI, 1.229-18.740; P = 0.024) were independent predictors of in-hospital mortality in patients with CRKP infections. Kaplan-Meier curves showed that the CRKP group had a shorter survival time than the CSKP group.

Conclusion: Nosocomial CRKP infection was associated with exposure to carbapenems and ﬂuoroquinolones within 3 months prior to hospitalization and the presence of a nasogastric tube. Patients infected with CRKP had higher 30-day and in-hospital mortality rates. A higher creatinine level, shock and co-infection with other resistant bacteria were independent predictors of in-hospital mortality in patients with CRKP infections.

Keywords: carbapenem-resistant Klebsiella pneumoniae; clinical outcomes; nosocomial infection; risk factors.