Characteristics of patients
Overall, 90 patients with CRKP BSI met the inclusion criteria. Ultimately, according to the inclusion and exclusion the unique episodes were included in the analysis (Fig 1). The demographic and clinical characteristics of patients with CRKP-BSIs are presented in Table 1. CRKP-BSI cases mainly occurred in subjects aged over 60 years (72%). The median patient age was 68 years (interquartile range 21–93 years), and 64 of 90 patients (67 %) were males. All episodes of CPKP BSIs were either hospital acquired (85%) or healthcare associated (10%), while none was community acquired.
The most common disease was diabetes (27%), Previous Surgery (44%) or intracranial disease (30%), gastrointestinal hemorrhage (20%), chronic kidney disease (17%), cardiovascular disease (4%) and solid tumors (15%). There were 3(3%) cases involving solid organ transplantation and 12(13%) receiving chemotherapy. Overall, 39% of patients underwent Corticosteroids use. 12 (13%) patients received immunosuppressive therapy (cyclosporine or leflunomide) to treat systemic lupus erythematosus (Fig 2). The median Charlton comorbidity index (CCI) and Pitt bacteremia score at onset were 4 (interquartile range3-5) and 3 (interquartile range 2.0-6.0), respectively. The invasive Procedures was indwelled Urinary catheter (69%), indwelled central venous catheter (72%), mechanically ventilated (45%), gastrointestinal decompression (63%), renal replacement therapy (14%) (Fig 2).
Increased rates of CRKP-BSIs, including ICU and Non-ICU patients
In our study, 90 unique episodes of CRKP-BSI were included, 57 % (51/90) of the CRKP isolates were came from ICU and 43% (39/90) of the CRKP BSI patients were came from non-ICU. We discovered that the occurrence of bloodstream infection causing nosocomial carbapenem-resistant Klebsiella pneumonia is increasing since 2016, and the rates of infections are much higher than the national average in the hospital included in this study. The percent of CRKP-BSI mortality in this study are presented in Fig 3. The percentage of overall mortality increased from 60% in 2016 to 65% in 2017, with the highest rate obtained in 2018, up to 69% of CRKP BSI patients in our hospital. A similar trend, the rates of CRKP BSI mortality acquired from our Hospital in intensive care unit, rising from 60% in 2016 to 66.7% in 2017 and 78.9% in 2018. Simultaneously, the rates of CRKP BSI mortality acquired from our Hospital in non-ICU, rising from 61.5% in 2016 to 62.5% in 2017, descending 58.8% in 2018(Fig 3).
Risk factors for mortality of CRKP BSI patients
Overall in-hospital crude mortality was 65% (59/90), similar to the previous studies[17]. Our results indicate that the invasive Procedures was indwelled Urinary catheter (69%), indwelled central venous catheter (72%), mechanically ventilated (45%), gastrointestinal decompression (63%), renal replacement therapy (14%) (Table 1). Previous studies have evaluated several risk factors for the mortality associated with CRKP BSI, including use of indwelled Urinary catheter, indwelled central venous catheter, mechanically ventilated and exposure to carbapenems. However, in our analysis, gastrointestinal hemorrhage (p=0.029), Pitt bacteremia score (P=0.045), Charlton comorbidity index (p=0.018) and Corticosteroids therapy (p=0.036) and Septic shock (p=0.001) were associated with risk factors for mortality (Fig 4). In univariate analyses, variables significant at p < 0.05 were included in the multivariate analysis. On multivariate analyses, septic shock (adjusted odds ratio [aOR] 5.591, 95% confidence interval [CI] 1.405-22.246, P=0.015) and Corticosteroids therapy (aOR 4.148, 95% CI 1.331-12.928, P=0.014) were independently associated with a risk effect on mortality (Table 2).
Therapeutic characteristics
As defined in Materials and methods, 53 patients (58.8%) received early appropriate therapy, and 37 patients who received inappropriate therapy. Fifty-there patients received at least one active antibiotic, including 45 patients who received Tigecycline-based therapy (84.7%, 45/53), one patient who received Polymyxin B -based therapy and 7 who received Tigecycline combine Polymyxin B (13.2 %, 7/53). The clinical characteristics of patients who underwent Tigecycline-based therapy, Polymyxin B -based therapy and Tigecycline combine Polymyxin B were summarized in FIG 4.