Risk Factors and Mortality for Patients with Bloodstream Infections of Klebsiella Pneumoniae During 2014-2018: Clinical Impact of Carbapenem Resistance in a Large Tertiary Hospital of China.

Background: Bloodstream infection (BSI) caused by Klebsiella pneumoniae (KP), especially carbapenem-resistant KP (CRKP), results in high morbidity and mortality. Aims: We aim to identify risk factors that associated with the mortality of patients with KP BSI, as well as predictors of developing CRKP BSI. Results: In this retrospective cohort study, we examined 285 inpatients with BSI caused by KP in a tertiary hospital in China between 2014 and 2018, and 46 patients were infected with CRKP. We identified that hematological tumor (odds ratio (OR): 8.359, [95% CI: 2.162-33.721],P = 0.002), CRKP isolation (OR: 7.766, [95% CI: 2.796-21.576], P = 0.001), chronic lung disease (OR: 5.020, [95% CI: 1.275-19.768], P = 0.020), and septic shock (OR: 4.591, [95% CI: 1.686-12.496], P = 0.003) were independent risk factors for the death of KP BSI. A 28-day mortality of KP BSI score ranging from 0 to 22 was developed based on the above 4 inde-pendent variables. Our scoring system revealed that the 28-day mortality were 9.14%, 35.29%, 38.10 %, 75% and 100% for carriers with a score of 0, 5, 6-10, 11-13 and >= 14, respectively. Additionally, CRKP infection were independently associated with intensive care unit stay ( OR: 5.506, [95% CI: 2.258-13.424],P = 0.001), exposure to antifungals (OR: 4.679, [95% CI: 2.065-10.063], P = 0.001), exposure to fluoroquinolones (OR: 2.892, [95% CI: 1.151-7.267], P = 0.020), and the number of isolated bacterial species from the patient >= 3 (OR: 2.414, [95% CI: 1.306-4.463], P = 0.005). Conclusion: Our study may be useful for the reduction of the mortality of patients with KP BSI and the prevention of developing CRKP BSI in hospitals. (C) 2019 Nanjing Medical University. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.