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Abstract：
Bloodstream infections caused by multidrug-resistant organisms such as Klebsiella pneumoniae are a significant challenge in managing hematological malignancies. This study aims to characterize the epidemiology of Klebsiella pneumoniae bloodstream infections specifically in patients with hematological malignancies, delineate the patterns of initial antibiotic therapy, assess the prevalence of resistant strains, identify risk factors for these resistant strains, and evaluate factors influencing patient outcomes. A retrospective analysis was conducted at a single center from January 2017 to December 2020, focusing on 182 patients with hematological malignancies who developed Klebsiella pneumoniae bloodstream infections. We compared the 30-day mortality rates between patients receiving appropriate and inappropriate antibiotic treatments, including the effectiveness of both single-drug and combination therapies. Kaplan-Meier survival analysis and multivariate logistic and Cox regression were used to identify factors influencing mortality risk. The 30-day all-cause mortality rate was 30.2% for all patients. The 30-day all-cause mortality rates were 77.2% and 8.8% in patients who received inappropriate initial treatment and appropriate initial treatment (p < 0.001). Inappropriate initial treatment significantly influenced mortality and was a key predictor of 30-day mortality, along with septic shock and previous intensive care unit (ICU) stays. Patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections exhibited more severe clinical symptoms compared to the CSKP group. The study demonstrates a significant association between empirical carbapenem administration and the escalating prevalence of CRKP and multidrug-resistant K. pneumoniae (MDR-KP) infections. Furthermore, the study identified inappropriate initial antibiotic therapy, septic shock, and ICU admission as independent risk factors for 30-day mortality.
摘要：
由多重耐药生物体如肺炎克雷伯菌引起的血流感染是管理血液恶性肿瘤的重大挑战。本研究旨在描述肺炎克雷伯菌血流感染的流行病学特征，特别是在血液系统恶性肿瘤患者中，描绘初始抗生素治疗的模式，评估耐药菌株的患病率，确定这些耐药菌株的风险因素，并评估影响患者预后的因素。回顾性分析2017年1月至2020年12月在单个中心进行的，重点是182例发生肺炎克雷伯菌血流感染的血液恶性肿瘤患者。我们比较了接受适当和不适当抗生素治疗的患者30天死亡率，包括单药和联合治疗的有效性。采用Kaplan-Meier生存分析和多因素logistic和Cox回归分析确定影响死亡风险的因素。所有患者30天全因死亡率为30.2%。在接受不适当的初始治疗和适当的初始治疗的患者中，30天全因死亡率分别为77.2%和8.8%(p<0.001)。不适当的初始治疗显着影响死亡率，并且是30天死亡率的关键预测指标。以及感染性休克和以前的重症监护病房（ICU）。与CSKP组相比，耐碳青霉烯类肺炎克雷伯菌（CRKP）血流感染的患者表现出更严重的临床症状。该研究表明，碳青霉烯的经验性给药与CRKP和多药耐药肺炎克雷伯菌（MDR-KP）感染的患病率上升之间存在显着关联。此外，该研究发现初始抗生素治疗不适当，感染性休克,和入住ICU是30天死亡率的独立危险因素。
