Clinical Features And Prognosis Evaluation Of Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections:Factors Related To Patient Mortality

Purpose:To evaluat the clinical features,risk factors related to mortality and the rationality of drug treatment of the Carbapenem-Resistant Klebsiella pneumoniae bloodstream infections via this retrospective study.Methods:A retrospective study was conducted in a teaching hospitals in Zhe Jiang province,we examined 50 patients with bloodstream infections(BSIs)caused by Carbapenem-Resistant isolates(CRKP)diagnosed between 1 January 2011 and 1 October 2016.We evaluated the clinical features and the treatment of the CRKP-BSI,the outcome measured was death within 28 days of the first positive blood culture.Survivor and nonsurvivor subgroups were compared to identify predictors of mortality.Results:A total of 50 incidences of CRKP-BSIs were identified in a 5-year period,the CRKP-BSI was mostly observed in old patient with More than 2 basic diseases.Most common infection sources were intraabdominal(36%),lung(20%),and Catheter-related(28%)bloodstream infection.98%(49/50)of the isolates had an Imipenem MIC ?16 mg/L.Only 20%(10/50)of the cases achieved a reasonable treatment lasting more than 7 days with high dose tigecycline(HDT)in 2 patients.In a subgroup analysis of tigecycline treatment group and unreasonable treatment group,there has no statistically significant difference in the change of CRP(p>0.05).The overall 28-day mortality rate was 50%.A significantly higher rate was observed among patients with higher fever(61%vs 33%,p=.042),suffering from hematological tumor(28%vs 0%,p=.014)and septic shock((52%vs 12%,p=.002))at BSI onset.And the survivals was more likely to pulling out the deep venous catheter in time(32%vs 8%,p=034).In logistic regression analysis,28-day mortality was independently associated with septic shock at BSI onset(odds ratio[OR]:9.043;95%confidence interval[CI]:1.912-42.77;P =.005).Conclusions:CRKP-BSIs are associated with high mortality,and was mostly observed in old patient with basic diseases and risk factors.Patients suffering from hematological tumor had poorer clinical prognosis.28-day mortality was independently associated with septic shock at BSI onset.