Risk Factors of 30-Day All-Cause Mortality in Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection

Keh-Sen Liu; Yao-Shen Tong; Ming-Tsung Lee; Hung-Yu Lin; Min-Chi Lu

doi:10.3390/jpm11070616

Risk Factors of 30-Day All-Cause Mortality in Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection

J Pers Med. 2021 Jun 29;11(7):616. doi: 10.3390/jpm11070616.

Authors

Keh-Sen Liu¹, Yao-Shen Tong², Ming-Tsung Lee^{3

4}, Hung-Yu Lin³, Min-Chi Lu^{5

6}

Affiliations

¹ Division of Infectious Diseases, Department of Internal Medicine, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
² Department of Medical Laboratory, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
³ Research Assistant Center, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
⁴ Department of Nursing, Hungkuang University, Taichung 433, Taiwan.
⁵ Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan.
⁶ Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung 404, Taiwan.

Abstract

An optimal antimicrobial regimen for the treatment of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is currently unavailable. This study aimed to identify the appropriate antibiotics and the risk factors of all-cause mortality for CRKP BSI patients. This retrospective cohort study included the hospitalized patients with CRKP BSI. Primary outcome was 30-day all-cause mortality. Cox regression analysis was used to evaluate the risk factors of 30-day mortality. A total of 89 patients were included with a 30-day mortality of 52.1%. A total of 52 (58.4%) patients were treated with appropriate antimicrobial regimens and 58 (65.2%) isolates carried bla_KPC-2 genes. Microbiologic eradication within 7 days (adjusted hazard ratio [HR] = 0.09, p < 0.001), platelet count (per 1 × 10⁴/mm³, adjusted HR = 0.95, p = 0.002), and Pitt bacteremia scores (adjusted HR = 1.40, p < 0.001) were independently associated with 30-day all-cause mortality. No effective antimicrobial regimens were identified. In conclusion, risk factors of 30-day mortality in patients with CRKP BSI included microbiologic eradication > 7 days, lower platelet count, and a higher Pitt bacteremia score. These findings render a new insight into the clinical landscape of CRKP BSI.

Keywords: Klebsiella pneumoniae; bacteremia; carbapenem-resistant Enterobacteriaceae; carbapenemase; mortality; risk factors.