Infection and Drug Resistance (Aug 2022)
Risk Factors for Mortality and Outcomes in Hematological Malignancy Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections
Abstract
Haiyang Meng,1 Lu Han,2 Mengxia Niu,3 Lu Xu,4 Min Xu,5 Qi An,1 Jingli Lu1 1Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 2Department of Pharmacy, Zhengzhou Second People’s Hospital, Zhengzhou, People’s Republic of China; 3Department of Pharmacy, Zhengzhou Western Hospital of Traditional Chinese Medicine, Zhengzhou, People’s Republic of China; 4Department of Clinical Laboratory, Henan Children’s Hospital, Zhengzhou, People’s Republic of China; 5Department of Clinical Laboratory, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of ChinaCorrespondence: Jingli Lu, Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China, Tel +86-371-66913047, Email [email protected]: This study aimed to identify risk factors for mortality and outcomes in hematological malignancy (HM) patients with bloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP).Methods: A retrospective study was conducted at a tertiary teaching hospital in Henan Province, China, between January 2018 and December 2021. All BSIs caused by CRKP in hospitalized HM patients were identified. Data on patient demographics, disease, laboratory tests, treatment regimens, outcomes of infection, and the antimicrobial susceptibility of each isolate were collected from medical records.Results: A total of 129 patients with CRKP BSI were included in the study, and the 28-day mortality rate was 80.6% (104/129). In Cox analysis an absolute neutrophil count < 500 at discharge (hazard ratio [HR] 6.386, 95% confidence interval [CI] 3.074– 13.266, p < 0.001), intensive care unit admission (HR 1.834, 95% CI 1.065– 3.157, p = 0.029), and higher Pitt bacteremia score (HR 1.185, 95% CI 1.118– 1.255, p < 0.001) were independent risk factors associated with 28-day mortality. Survival curve analysis indicated that compared with ceftazidime-avibactam-based therapy, both polymyxin b (HR 8.175, 95% CI 1.099– 60.804, p = 0.040) and tigecycline (HR 14.527, 95% CI 2.000– 105.541, p =0.008) were associated with a higher risk of mortality.Conclusion: In HM patients CRKP BSI resulted in high mortality. Intensive care unit admission, higher Pitt bacteremia score, and absolute neutrophil count < 500 at discharge were independently associated with higher mortality. Early initiation of new agents such as ceftazidime-avibactam may improve outcomes.Keywords: bloodstream infection, carbapenem-resistant Klebsiella pneumonia, hematological malignancy, risk factor
