In recent years, carbapenem-resistant Klebsiella pneumoniae (CRKP) associated bacterial infections have spread worldwide becoming a serious global public health problem in a number of countries, including China. Surveillance of antibiotic resistance by the China CHINET reported that the rate of carbapenem-resistant Klebsiella pneumoniae isolates increased from 2.4% in 2005 to 13.4% in 2014. The studies were to demonstrate the epidemiological, clinical characteristics and the risk factors for predictors of mortality in south china. While our study has been collected in a single medical center, the samples were date from the First Affiliated Hospital of Wenzhou Medical University, which is one of the largest integrated teaching hospitals, clinical practice and scientific research.
CRKP-BSI cases mainly occurred in aged over 60 years (72%) and more frequently in males (67%) than in females. Confirmation of this finding is also available in the European Centers for Disease Control and Prevention database, where the higher proportion of carbapenem-resistant K. pneumoniae in males is particularly evident in countries at high prevalence of carbapenem resistance such as Italy and Romania. The reason for the higher incidence of CRKP-BSI in males than in females is not clear, but it is worth noting that the higher incidence of sepsis in males is associated with genetic susceptibility . In our study, we observed an increase in CRKP-BSI with age. This increase, especially for patients 60 years of age and older, may be associated with the high vulnerability in the elderly, which may determine higher frequencies and longer hospital stays than younger patients.
The patient population affected by CPKP BSI had several evident characteristics; all episodes of BSIs were either hospital or health care associated. The data showed that the rate of hospital-acquired infections was 66%, however, 75% of the patients who died had hospital-acquired infection from the CRE Epicenter of the United States. Our data showed that the rate of 90% CRKP BSI patients had hospital-acquired infection, while none was community acquired. It is important for physician to control hospital infection as soon as possible.
Carbapenem-resistant Klebsiella pneumoniae (CRKP) Bloodstream infections(BSI) are becoming an crisis of global dimensions, including ICU and Non-ICU patients, due to high morbidity and mortality. In our study, 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. The overall mortality obviously increased from 60% in 2016 to 65% in 2017, with the highest rate obtained in 2018, up to 69%. This discrepancy probably caused by Zhejiang Province is one of the highest CRKP infections prevalence’s region in China. It is a major clinical finding that the morbidity and mortality of CRKP BSIs patient in ICU and non-ICU was no significant difference. A possible explanation may be that standardizing operation and improving nurse quality is vital key to the critically CRKP BSI patient in intensive care unit. Furthermore, characterized by advanced technology to care for severely patients and early appropriate therapy in intensive care unit, which may lead to the difference from previous data. It is a monocentric study that our data may be different from other centers. Therefore, further multi-centric studies are needed to confirm our findings.
Bloodstream infections causing by Carbapenem-resistant Klebsiella pneumoniae (CRKP) clinical characteristics have been attributed to the various aspects. In previous study, it is more frequent among patients associated with CRKP BSIs with severe chronic comorbidities, but chronic comorbidities were not risk factors for CRKP BSI. As consistently shown in our studies, comorbidities were not independent risk factors for CRKP BSI. Furthermore, our studies show that indwelling central venous catheter and urinary catheter were not independent risk factors for CRKP BSI, which is different with previous studies. The reason for this might associated with the small number of CRKP BSI cases in the study. All the patient peripheral blood lymphocytes before bloodstream infection were decreased in CRKP in this study. It may help physicians pay more attention to the patients who have a higher risk of bloodstream infection when the lymphocytes decreased.
The mortality rates associated with CRKP BSI have been widely reported and they range from 40–70%[25, 26]. Overall, the rate of mortality in our patients with CRKP BSI was higher (65%) compared to the findings of previously studies . Previous studies have evaluated several risk factors for the mortality associated with CRKP BSI, including use of corticosteroid, use of invasive devices, septic shock and exposure to carbapenems[27–29]. Fig-4 shows that CRKP BSI was related to gastrointestinal hemorrhage, Pitt bacteremia score, Charlton comorbidity index and Corticosteroids use and Septic shock. Septic shock and Corticosteroids use were independent risk factors for CRKP BSI, which is different with previous reported. The reason for this might provide an explanation that the regional differences and effective Hospital Infection-Control of CRKP BSI in our study. Corticosteroid should be added to septic shock patients according to the Surviving Sepsis Campaign guidelines. In our study, an alarming finding is that the use of corticosteroids as adjunctive therapy in CRKP infections has deleterious effects. The most important risk factor for mortality in our study was septic shock at CRKP BSI onset; not surprisingly, this variable had been found to be associated with mortality in several previous studies performed on general population patients with CRKP BSI[8, 31].
There were several limitations associated with this study. First, the current study was a retrospective, single-center study including 90 patients with clinical analysis. Second, Clinical data were obtained retrospectively from medical records, and there may be some differences in physician practices or accuracy of information. Finally, prospective and further multi-centric studies are needed to confirm our findings.