Risk Factors for and Clinical Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Nosocomial Infections: A Retrospective Study in a Tertiary Hospital in Beijing, China

Abstract

Huijuan Zhang,1,2 Zhe Guo,1,3 Yan Chai,1 Yi-Peng Fang,1 Xiangdong Mu,1,2 Nan Xiao,4 Jun Guo,1,2 Zhong Wang1,5 1School of Clinical Medicine, Tsinghua University, Beijing, 100084, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People’s Republic of China; 3Department of Liver Intensive Care Unit, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People’s Republic of China; 4Department of Laboratory Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People’s Republic of China; 5Department of General Practice Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, People’s Republic of ChinaCorrespondence: Jun GuoDepartment of Pulmonary and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, People’s Republic of ChinaTel/Fax [phone]Email [email protected] WangDepartment of General Practice Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, People’s Republic of ChinaTel/Fax [phone]Email [email protected]: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections have been increasingly reported worldwide. We aimed to identify the risk factors for nosocomial CRKP infections and assess the clinical outcomes.Patients and Methods: We conducted a case-control study with data collected from January 2016 to December 2018 in China. Controls were selected at a ratio of 1:1 from patients with nosocomial carbapenem-susceptible Klebsiella pneumonia (CSKP) infections. Risk factors for nosocomial CRKP infections and clinical outcomes were assessed with univariate and multivariate analyses.Results: A total of one hundred forty-two patients with CRKP infections and one hundred forty-two patients with CSKP infections were enrolled in this study. Multivariate analysis showed that exposure to antibiotics within 3 months prior to admission (odds ratio OR, 2.585; 95% confidence interval [CI], 1.425– 4.691; P=0.002), exposure to carbapenems (OR, 2.532; 95% CI, 1.376– 4.660; P=0.003), exposure to fluoroquinolones (OR, 3.309; 95% CI, 1.326– 8.257; P=0.010), and the presence of a nasogastric tube (OR, 2.796; 95% CI, 1.369– 5.712; P=0.005) were independent risk factors for CRKP infections. The 30-day mortality rate in the CRKP group was 19.7%, while the in-hospital mortality rate was 28.9%. In the CRKP group, a higher creatinine level (OR, 1.009; 95% CI, 1.002– 1.016; P = 0.013), being in shock at the time of a positive culture (OR, 4.454; 95% CI, 1.374– 14.443; P = 0.013), and co-infection with other resistant bacteria (OR, 4.799; 95% CI, 1.229– 18.740; P = 0.024) were independent predictors of in-hospital mortality in patients with CRKP infections. Kaplan–Meier curves showed that the CRKP group had a shorter survival time than the CSKP group.Conclusion: Nosocomial CRKP infection was associated with exposure to carbapenems and fluoroquinolones within 3 months prior to hospitalization and the presence of a nasogastric tube. Patients infected with CRKP had higher 30-day and in-hospital mortality rates. A higher creatinine level, shock and co-infection with other resistant bacteria were independent predictors of in-hospital mortality in patients with CRKP infections.Keywords: carbapenem-resistant Klebsiella pneumoniae, risk factors, clinical outcomes, nosocomial infection

Keywords

• carbapenem-resistant klebsiella pneumoniae
• risk factors
• clinical outcomes
• nosocomial infection