Analysis Of The Morbidity,Mortality And Risk Factors Of Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infection In The Department Of Hematology

Objective: To observe the 5-year changes in the incidence and mortality of carbapenem resistant Klebsiella pneumonia(CRKP)bloodstream infection(BSI)and risk factors in the department of hematology,and provide evidence for the early identification,prevention and control of CRKP-BSI in the department of hematology.Methods: The drug resistance of Klebsiella pneumoniae(KP)in blood culture from January 1,2015 to August 31,2020 was collected by whonet 5.7software system.The clinical data of 114 patients with KP-BSI were analyzed retrospectively,they were divided into CRKP-BSI group(n=33)and carbapenem sensitive Klebsiella pneumoniae(CSKP)BSI group(n=81).The drug resistance rate of KP to carbapenems,the mortality rate and related clinical indicators of the two groups were analyzed,univariate analysis and multivariate logistic regression analysis were used to determine the risk factors for the occurrence and death of CRKP-BSI.Results: 1.The incidence of CRKP-BSI in the department of hematology rose from 22.2% in 2015 to 40.7% in 2017.It declined after 2017,but remained at 22.2%.2.The five-year KP-BSI hospital mortality rate was 22.8%,and the mortality rate of the CRKP group and CSKP group were 39.4% and16.0%,respectively(P=0.007).3.The independent risk factors for the occurrence of CRKP-BSI were: application of carbapenem antibiotics within one month before the onset(OR:10.916,[95%Cl:1.895-62.873],P=0.007),application within one month before the onset third or fourth generation cephalosporins(OR:4.186,[95%Cl:1.354-12.937],P=0.013).4.High Pitt bacteremia score(OR:5.283,[95%Cl:1.914-14.585],P=0.001)and acute respiratory failure(OR:35.854,[95%Cl:1.232-1043.662],P=0.037)were independent risk factors related to hospital death in KP-BSI patients.5.High Pitt bacteremia score(OR:5.519,[95%Cl:1.585-19.214],P=0.007)was an independent risk factor for hospital death in CSKP-BSI patients.Conclusions:1.The incidence of CRKP-BSI in hematology department increased from2015 to 2017,and decreased after 2017.2.The in-hospital mortality of patients with KP-BSI in hematology department showed an upward trend from 2015 to 2019,and a down-ward trend after 2019.3.The independent risk factors of CRKP-BSI in hematology department were the use of carbapenems within one month before the onset of CRKP-BSI,and the use of third or fourth generation cephalosporins within one month before the onset of CRKP-BSI.4.High Pitt bacteremia score and acute respiratory failure were independent risk factors for in-hospital death in patients with KP-BSI in hematology department.5.High Pitt bacteremia score was independent risk factors for in-hospital death in patients with CSKP-BSI in hematology department.