| Background:Klebsiella pneumoniae(KP)is a significant opportunistic pathogen that commonly colonizes in the respiratory tract and intestinal tract of humans.In individuals with compromised immunity,KP can lead to various infections,including bloodstream infections,which are associated with poor prognosis.The incidence of KP bloodstream infections has been increasing annually,attributed to the aging population,higher number of critically ill patients,and widespread use of immunosuppressive agents.KP is one of the most important gram-negative pathogens responsible for bloodstream infections,ranking second to Escherichia coli.Furthermore,the increasing marketing time and irrational use of carbapenems have contributed to an increased detection rate of carbapenem-resistant klebsiella pneumoniae(CRKP).As a result,the proportion of bloodstream infections caused by CRKP has also increased,with a high mortality rate of71.9%.Multi-site infections were frequently observed in patients with CRKP bloodstream infections,with approximately 65.9% of patients exhibiting pulmonary infection or other site infections.It is widely recognized that patients with multi-site infections often have complicated medical conditions and limited access to effective antibiotics,leading to a poor prognosis.Consequently,identifying and eliminating the focus of infection is a critical step in the management of these patients.Lower respiratory tract infections represent the most common source of CRKP bloodstream infections.Studies conducted earlier indicated that about 50% of CRKP bloodstream infections are associated with a secondary infection in the lung.In summary,patients with CRKP bloodstream infections and multi-site CRKP infections have a serious condition and poor prognosis,but the clinical characteristics and risk factors are still inadequately researched.Objective:1.To explore risk factors associated with the death of patients with CRKP bloodstream infection,so as to identify high-risk groups at an early stage,and then take effective intervention to reduce the mortality rate2.To obtain the clinical characteristics and risk factors of CRKP multi-site infection,which will help to take targeted measures to control the diseases.3.To clarify the clinical characteristics of patients with pneumonia-related bloodstream infections caused by CRKP and find out the associated risk factors,offering a theoretical foundation for the diagnosis and treatment.Methods:1.We selected CRKP bloodstream infections patients in our hospital from January2015 to December 2022 as the research population.Demographic data like age,gender,microbiological characteristics,therapy and prognosis were collected and analyzed.All patients were divided into two groups,the survivor group and the death group,according to their outcome.2.The subjects of this study were CRKP bloodstream infections treated in our hospital from January 2015 to December 2022.According to the presence of other site infections,all patients were further subdivided into the multi-sites infections group and single-site infection group.Univariate analysis and logistic regression analysis were used to find independent risk factors of CRKP multi-sites infections.3.Patients with ICU-acquired CRKP pneumonia in our hospital from January 2020 to December 2022 were included in the study.According to the presence of pneumonia-related CRKP bloodstream infections,all patients were subdivided into pneumonia-related CRKP bloodstream infections group and non-pneumonia-related CRKP bloodstream infections group.The clinical data of two groups were analyzed to investigate the risk factors associated with pneumonia-related CRKP bloodstream infections.Results:1.Clinical characteristics and risk factors for the mortality of CRKP bloodstream infections:(1)a total of 144 patients with CRKP bloodstream infections were enrolled,including 109 males and 35 females,with a median age of 58.5(48.3-68.0)years.The mortality rate was 40.3%.The most commonly detected department was Department of Gastroenterology(50 cases,34.7%).Severe acute pancreatitis was the most common admission diagnosis(32 cases,22.2%);(2)univariate analysis indicated that ICU admission,carbapenem exposure,tigecycline exposure,invasive mechanical ventilation,indwelling gastric tube,septic shock,a PBS>4,thrombocytopenia and the presence of other site infections were related to the mortality of CRKP bloodstream infections;(3)multivariate analysis suggested that a PBS >4(OR=3.328,P=0.005,95%CI: 1.434-7.726),indwelling gastric tube(OR=2.625,P=0.028,95%CI: 1.110-6.338),thrombocytopenia(OR=5.229,P<0.001,95%CI: 2.319-11.789),and the presence of other site infections(OR=3.704,P=0.003,95%CI: 1.559-8.796)were independent risk factors for mortality.2.Clinical characteristics and risk factors for CRKP multi-sites infections:(1)among144 patients with CRKP bloodstream infections,there are 104(72.2%)patients in the multi-sites infections group and 40(27.8%)patients in the single-site infection group.Besides blood samples,CRKP could be found in one site in 53(51.0%)patients and at least two sites in 51(49.0%)patients in the multi-sites infections group.Most isolates were collected from sputum(65 cases,58.7%).The most commonly detected department was Department of Gastroenterology(43 cases,41.3%).Severe acute pancreatitis was the most common admission diagnosis(28 cases,26.9%).The mortality rate was 47.1%,which was significantly higher than that of single-site infection group(22.5%).(2)univariate analysis suggested that gender,ICU admission,ICU length of stay,hospital length of stay,a PBS> 4,invasive mechanical ventilation,indwelling gastric tube,and previous surgery were associated with CRKP multi-site infections.(3)multivariate analysis suggested that previous surgery(OR=4.111,95%CI: 1.907-8.861,P<0.001),invasive mechanical ventilation(OR=2.778,95%CI: 1.308-5.900,P=0.008)and ICU admission(OR=3.672,95%CI: 1.714-7.868,P=0.001)were independent risk factors for the mortality of CRKP multi-site infections.3.Clinical characteristics and risk factors for pneumonia-related CRKP bloodstream infections:(1)98 patients with ICU acquired CRKP pneumonia were included in this study,of which 25(25.5%)patients suffered from pneumonia-related CRKP bloodstream infections.The mortality was 48.0%,which was significantly higher than that of patients without pneumonia-related CRKP bloodstream infections(21.9%).(2)univariate analysis indicated that gender,ICU length of stay,COPD,diabetes,a higher APACHE Ⅱ score,a higher CPIS score,hypoalbuminemia,invasive mechanical ventilation and indwelling urinary catheter were associated with pneumonia-related CRKP bloodstream infection.(3)multivariate analysis suggested that COPD(OR=3.310,95%CI: 1.283-8.543,P=0.013),diabetes(OR=3.389,95%CI: 1.232-9.319,P=0.018)and hypoalbuminemia(OR=1.667,95%CI: 0.330-8.432,P=0.037)were independent risk factors for pneumonia-related CRKP bloodstream infection.Conclusions:1.Patients with CRKP bloodstream infections were associated with a extremely high mortality rate.High PBS,thrombocytopenia,indwelling gastric tube and the presence of other sites infection were independent risk factors for mortality.2.Patients with CRKP multi-sites infections were associated with a poor prognosis.Timely treatment of primary infection,reduction of unnecessary surgery,invasive mechanical ventilation and ICU admission will help reduce the incidence of CRKP multi-sites infections.3.COPD,diabetes and hypoproteinemia were independent risk factors for pneumonia-related CRKP bloodstream infection.When the above factors exist in patients with CRKP pneumonia,clinicians should be alert to the occurrence of secondary bloodstream infection.It is advised to take blood culture samples as soon as possible and start anti-infection treatment in time. |
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