Risk Factors For Death And Antibiotic Efficacy Analysis Of Carbapenem-resistant K.pneumoniae Infection

Objective:Carbapenem-resistant K.pneumoniae(CRKP)is one of the common pathogens of severe infections,this paper aims to explore the mortality risk factors and compare efficacy of different patterns of antibiotics in patients with CRKP infection,thus enable clinicians to evaluate patient’s prognosis and treat CRKP.Data collection and methods: This study retrospectively included 137 patients with CRKP infection with complete data during the year of 2019 to 2020 in the Third Xiangya Hospital of Central South University.Patients were divided into death and survival groups according to the clinical outcome.Univariate and multivariate regression analysis of the risk factors of mortality and the efficacy of different antibiotic regimens was performed using the stata MP16(64-bit).Results: Clinical data of 137 patients infected with CRKP were collected,with the all-cause mortality of 45.99%.Immune impairment(P=0.009),Acute Physiology and Chronic Health Evaluation(APACHEII score)(P=0.022)were independent risk factors for mortality.91 patients were included in the antibiotic efficacy analysis study,with an overall survival rate of 59.34%.88 patients in the combined treatment group(including two-drug combination and three-drug combination),with a survival rate of 59.09%.The survival rate of patients treated with amikacin,tigecycline,and polymyxin were 64.29%,56.25%,and 52.38%respectively,but there was no significant difference between them(X2=0.7431,P=0.6897).Both the meropenem or imipenem MIC values of the KP infected in this study were greater than or equal to 16mg/L.In the combination regimen,the survival rate of the carbapenem-containing group was lower than that of the noncarbapenem group,with significant differences(54.55% verses 85.71%,P=0.0381).A tatal of five patients were treated with ceftazidime-avibactam(including monotherapy and combination therapy),with a survival rate of 80.0%.Conclusion: History of the immunosuppressive therapy,Acute Physiology and Chronic Health Evaluation(APACHEII score)were independent risk factors for mortality;when meropenem or imipenem MIC values of the KP were greater than or equal to 16mg/L,carbapenemcontaining regimens may does not benefit to the clinical outcome;patients treated with amikacin in the combination regimen have better outcomes,and ceftazidime-avibactam may be an effective new antibiotic option for CRKP infection.