Infection and Drug Resistance (Dec 2021)
Clinical Characteristics and Risk Factors for Critically Ill Patients with Carbapenem-Resistant Klebsiella pneumoniae (CrKP): A Cohort Study from Developing Country
Abstract
Ying-Yi Luan,1,* Yan-Hong Chen,2,* Xue Li,3 Zhi-Peng Zhou,2 Jia-Jia Huang,2,4 Zhen-Jia Yang,2,4 Jing-Jing Zhang,2,5 Ming Wu2,4,6 1Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, People’s Republic of China; 2Department of Critical Care Medicine and Hospital Infection Prevention and Control, Shenzhen Second People`s Hospital & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, 518035, People’s Republic of China; 3Department of Emergency, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, People’s Republic of China; 4Shantou University Medical College, Shantou, 515041, People’s Republic of China; 5Department of Critical Care Medicine, Pingshan District People’s Hospital of Shenzhen, Shenzhen, 518118, People’s Republic of China; 6Guangxi University of Chinese Medicine, Nanning, 530200, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ming Wu Tel +86 755 83676149Email [email protected]: Increasing evidence indicates carbapenem-resistant Klebsiella pneumoniae (CrKP) is increasingly prevalent in intensive care unit (ICU), but its clinical characteristics and risk factors remain unknown.Aim: The aim of the present study was to evaluate clinical characteristics, risk factors in critically ill patients with CrKP infection.Methods: A retrospective study was included in patients from January 2013 to October 2019. Clinical data were collected from CrKP patients on the day of specimen collection admitted to ICU. Multivariable logistic regression was used for risk factors. Receiver operating curve (ROC) and the area under the curve (AUC) with DeLong method of MedCalc software were used. Two-way repeated-measures ANOVA analysis was used to analyze the characteristics of independent risk factors over time.Findings: A total of 147 adult patients with CrKP were screened, among them, 89 (median age 64.0 years, 66 (74.15%) males) patients with CrKP were finally included, of which 38 patients (42.7%) were non-survival group. Multivariate logistic regression analysis indicated that lactic acid (OR3.04 95% CI 1.38– 6.68, P = 0.006), APACHE II score (OR 1.20, 95% CI 1.09– 1.33, P < 0.001), tigecycline combined with fosfomycin treatment (OR0.15, 95% CI 0.04– 0.65, P = 0.011) are independent risk factors for 28-day mortality in patients with CRKP infection (P< 0.05). Combined lactic acid with APACHE II score could predict 28-day mortality, of which AUC value was 0.916 (95% CI, 0.847– 0.985), with sensitivity 0.76 and specificity 0.98. ANOVA analysis showed that APACHE II score and lactic acid between the two groups at three-time points were statistically significant, which interactive with time and showed an upward and downward trend with time (P < 0.05).Conclusion: Therapeutic strategy based on improving lactic acid and APACHE II would contribute to the outcome in patients with CrKP infection. Tigecycline combined with fosfomycin could reduce the 28-day mortality in patients with CrKP infection in developing country.Keywords: carbapenem resistant Klebsiella pneumoniae, lactic acid, APACHE II score, tigecycline, fosfomycin, mortality
