Clinical Characteristics And Mortality Risk Factors Of Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infection In Adults

Objective:With the wide application of carbapenem antibiotics,the number of bloodstream infections of carbapenem-resistant Klebsiella pneumoniae continues to increase,and the isolation rate of carbapenem-resistant Klebsiella pneumoniae in China is also on the rise.The aim of this study was to investigate the clinical features,risk factors for death,antimicrobial therapy and prognosis of CRKP bloodstream infection in adults.Methods:The clinical data of 209 patients with CRKP bloodstream infection with complete case data from January 2018 to December 2020 in the First Affiliated Hospital of Nanchang University were retrospectively analyzed.According to the28-day prognosis of bloodstream infection,the patients with CRKP bloodstream infection were divided into a survival group(100 cases)and a death group(109 cases),and the death-related risk factors of CRKP bloodstream infection patients were analyzed.At the same time,patients with CRKP bloodstream infection were divided into septic shock group(99 cases)and non-septic shock group(110 cases),and the risk factors of septic shock in patients with CRKP bloodstream infection were analyzed.Finally,the effects of different antimicrobial treatment regimens on the prognosis of patients were compared.Results:A total of 209 patients with CRKP bloodstream infection were included,most of whom were male.The mean age was 55.4±15.8 years.The most common underlying disease is hypertension.Urinary catheter placement is the most common invasive procedure.The 28-day case fatality rate was 52.2%(109/209).Age(OR=1.036,95%CI1.011 ～ 1.063,P=0.005),ERCP(OR=46.999,95%CI3.078 ～ 717.669,P=0.006),high APACHE Ⅱ score(OR=1.086,95%CI1.027～1.150,P=0.004),septic shock(OR=0.259,95%CI0.119～0.565,P=0.001)and MODS(OR=0.254,95%CI0.088～0.732,P=0.011)were independent risk factors for 28-day death in patients with CRKP bloodstream infection.Cerebrovascular disease(OR=0.239,95%CI0.078～0.733,P=0.012),MODS(OR=5.970,95%CI1.946 ～ 18.314,P=0.002),and 28-day mortality(OR=0.225,95%CI0.096～0.529,P=0.001)was an independent risk factor for septic shock in patients with CRKP bloodstream infection.There were statistically significant differences in the 28-day mortality between the treatment regimen containing tigecycline or polymyxin B and the group without tigecycline or polymyxin B.The mortality rate of tigecycline combined with meropenem in the combination regimen was 61.5%.Among the patients with tigecycline-based combination therapy,12 cases of CRKP had a MIC of tigecycline ≥4 mg/L,and the 28-day mortality rate was 83.3%;74 cases of tigecycline had a MIC of 2 mg/L,and the 28-day mortality rate was 83.3%.The incidence rate was 58.1%;the MIC of tigecycline was less than or equal to 1 in 5 cases,and the 28-day mortality rate was 80.0%.Conclusion:Age,ERCP,high APACHE Ⅱ score,septic shock and MODS can be used as independent risk factors to predict the prognosis of patients with CRKP bloodstream infection.Cerebrovascular disease,MODS,and 28-day mortality were independent risk factors for septic shock in patients with CRKP bloodstream infection.