Abstract：
BACKGROUND: In the present study, we aimed to describe the proportion of carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) in KP-BSI in one Chinese tertiary hospital over 10 years and determine the risk factors and outcomes of CRKP-BSI.
METHODS: We retrospectively analyzed clinical and microbiological data of patients with KP-BSI from January 2010 to December 2019 to identify risk factors, clinical features, and outcomes using multivariate logistic regression analysis. KP-BSI only included monomicrobial BSI and health care-acquired BSI.
RESULTS: Among the total 687 isolates of KP-BSI in this study, the rate of CRKP was 39.0% (268/687); this rate in the intensive care unit (ICU) was 65.6% and that in seven high-risk departments (including four ICUs, respiratory medicine, gastroenterology medicine, and hepatobiliary surgery) was 74.6%. The annual rate of CRKP in KP-BSI ranged from 0.0% in 2010 to 54.5% in 2019. The 28-day mortality was 36.2% in patients with CRKP-BSI and 11.7% in those with carbapenem-susceptible K. pneumoniae (CSKP) BSI. Multivariable logistic regression analysis showed that prior ICU stay (odds ratio [OR] 2.485, P < 0.001), hospital stay ≥ 30 days prior to BSI (OR 1.815, P = 0.007), prior mechanical ventilation (OR 2.020, P = 0.014), prior urinary catheter (OR 1.999, P = 0.003), prior carbapenem use (OR 3.840, P < 0.001), hepatobiliary disease (OR 2.943, P < 0.001), pancreatitis (OR 2.700, P = 0.026), and respiratory disease (OR 2.493, P = 0.009) were risk factors of CRKP-BSI. Patients with a first admission (OR 0.662, P = 0.046) had a lower percentage of CRKP-BSI.
CONCLUSIONS: The rapidly rising rate of CRKP-BSI in KP with high mortality requires increased attention. Exposure to carbapenems, ICU stay, invasive mechanical ventilation or urinary catheter, prolonged hospital stay, hepatobiliary disease, pancreatitis, and respiratory disease were found to be risk factors for CRKP-BSI. Strict control measures should be implemented to prevent the emergence and spread of CRKP, especially in high-risk departments.
METHODS: We retrospectively analyzed clinical and microbiological data of patients with KP-BSI from January 2010 to December 2019 to identify risk factors, clinical features, and outcomes using multivariate logistic regression analysis. KP-BSI only included monomicrobial BSI and health care-acquired BSI.
RESULTS: Among the total 687 isolates of KP-BSI in this study, the rate of CRKP was 39.0% (268/687); this rate in the intensive care unit (ICU) was 65.6% and that in seven high-risk departments (including four ICUs, respiratory medicine, gastroenterology medicine, and hepatobiliary surgery) was 74.6%. The annual rate of CRKP in KP-BSI ranged from 0.0% in 2010 to 54.5% in 2019. The 28-day mortality was 36.2% in patients with CRKP-BSI and 11.7% in those with carbapenem-susceptible K. pneumoniae (CSKP) BSI. Multivariable logistic regression analysis showed that prior ICU stay (odds ratio [OR] 2.485, P < 0.001), hospital stay ≥ 30 days prior to BSI (OR 1.815, P = 0.007), prior mechanical ventilation (OR 2.020, P = 0.014), prior urinary catheter (OR 1.999, P = 0.003), prior carbapenem use (OR 3.840, P < 0.001), hepatobiliary disease (OR 2.943, P < 0.001), pancreatitis (OR 2.700, P = 0.026), and respiratory disease (OR 2.493, P = 0.009) were risk factors of CRKP-BSI. Patients with a first admission (OR 0.662, P = 0.046) had a lower percentage of CRKP-BSI.
CONCLUSIONS: The rapidly rising rate of CRKP-BSI in KP with high mortality requires increased attention. Exposure to carbapenems, ICU stay, invasive mechanical ventilation or urinary catheter, prolonged hospital stay, hepatobiliary disease, pancreatitis, and respiratory disease were found to be risk factors for CRKP-BSI. Strict control measures should be implemented to prevent the emergence and spread of CRKP, especially in high-risk departments.
摘要：
背景：在本研究中，我们旨在描述中国一家三甲医院超过10年的KP-BSI中耐碳青霉烯类肺炎克雷伯菌血流感染(CRKP-BSI)的比例,并确定CRKP-BSI的危险因素和结局.
方法：我们回顾性分析了2010年1月至2019年12月KP-BSI患者的临床和微生物学数据，以确定危险因素。临床特征,和结果使用多变量逻辑回归分析。KP-BSI仅包括单抗微生物BSI和医疗保健获得的BSI。
结果：在本研究的687个KP-BSI分离株中，CRKP率为39.0%(268/687);重症监护病房(ICU)的这一比率为65.6%,七个高危部门(包括四个ICU,呼吸医学,胃肠病医学，肝胆手术）为74.6%。KP-BSI的CRKP年率从2010年的0.0%到2019年的54.5%不等。CRKP-BSI患者28天死亡率为36.2%，碳青霉烯类易感肺炎克雷伯菌(CSKP)BSI患者28天死亡率为11.7%。多因素logistic回归分析显示,ICU入住前(比值比[OR]2.485,P<0.001),BSI前住院时间≥30天（OR1.815，P=0.007），先前的机械通气（OR2.020，P=0.014），先前的导尿管（OR1.999，P=0.003），先前使用碳青霉烯（OR3.840，P<0.001），肝胆疾病（OR2.943，P<0.001），胰腺炎（OR2.700，P=0.026），呼吸系统疾病(OR2.493,P=0.009)是CRKP-BSI的危险因素。首次入院的患者（OR0.662，P=0.046）的CRKP-BSI百分比较低。
结论：在高死亡率的KP中，CRKP-BSI的快速升高率需要更多的关注。暴露于碳青霉烯类,ICU停留,有创机械通气或导尿管，住院时间延长,肝胆疾病,胰腺炎,发现呼吸道疾病是CRKP-BSI的危险因素。应实施严格的控制措施,防止CRKP的出现和蔓延,特别是在高风险部门。
方法：我们回顾性分析了2010年1月至2019年12月KP-BSI患者的临床和微生物学数据，以确定危险因素。临床特征,和结果使用多变量逻辑回归分析。KP-BSI仅包括单抗微生物BSI和医疗保健获得的BSI。
结果：在本研究的687个KP-BSI分离株中，CRKP率为39.0%(268/687);重症监护病房(ICU)的这一比率为65.6%,七个高危部门(包括四个ICU,呼吸医学,胃肠病医学，肝胆手术）为74.6%。KP-BSI的CRKP年率从2010年的0.0%到2019年的54.5%不等。CRKP-BSI患者28天死亡率为36.2%，碳青霉烯类易感肺炎克雷伯菌(CSKP)BSI患者28天死亡率为11.7%。多因素logistic回归分析显示,ICU入住前(比值比[OR]2.485,P<0.001),BSI前住院时间≥30天（OR1.815，P=0.007），先前的机械通气（OR2.020，P=0.014），先前的导尿管（OR1.999，P=0.003），先前使用碳青霉烯（OR3.840，P<0.001），肝胆疾病（OR2.943，P<0.001），胰腺炎（OR2.700，P=0.026），呼吸系统疾病(OR2.493,P=0.009)是CRKP-BSI的危险因素。首次入院的患者（OR0.662，P=0.046）的CRKP-BSI百分比较低。
结论：在高死亡率的KP中，CRKP-BSI的快速升高率需要更多的关注。暴露于碳青霉烯类,ICU停留,有创机械通气或导尿管，住院时间延长,肝胆疾病,胰腺炎,发现呼吸道疾病是CRKP-BSI的危险因素。应实施严格的控制措施,防止CRKP的出现和蔓延,特别是在高风险部门。
