Clinical Characteristics and Risk Factors for Critically Ill Patients with Carbapenem-Resistant Klebsiella pneumoniae (CrKP): A Cohort Study from Developing Country

Abstract

Background

Increasing evidence indicates carbapenem-resistant Klebsiella pneumoniae (CrKP) is increasingly prevalent in intensive care unit (ICU), but its clinical characteristics and risk factors remain unknown.

Aim

The aim of the present study was to evaluate clinical characteristics, risk factors in critically ill patients with CrKP infection.

Methods

A retrospective study was included in patients from January 2013 to October 2019. Clinical data were collected from CrKP patients on the day of specimen collection admitted to ICU. Multivariable logistic regression was used for risk factors. Receiver operating curve (ROC) and the area under the curve (AUC) with DeLong method of MedCalc software were used. Two-way repeated-measures ANOVA analysis was used to analyze the characteristics of independent risk factors over time.

Findings

A total of 147 adult patients with CrKP were screened, among them, 89 (median age 64.0 years, 66 (74.15%) males) patients with CrKP were finally included, of which 38 patients (42.7%) were non-survival group. Multivariate logistic regression analysis indicated that lactic acid (OR3.04 95% CI 1.38–6.68, P = 0.006), APACHE II score (OR 1.20, 95% CI 1.09–1.33, P < 0.001), tigecycline combined with fosfomycin treatment (OR0.15, 95% CI 0.04–0.65, P = 0.011) are independent risk factors for 28-day mortality in patients with CRKP infection (P<0.05). Combined lactic acid with APACHE II score could predict 28-day mortality, of which AUC value was 0.916 (95% CI, 0.847–0.985), with sensitivity 0.76 and specificity 0.98. ANOVA analysis showed that APACHE II score and lactic acid between the two groups at three-time points were statistically significant, which interactive with time and showed an upward and downward trend with time (P < 0.05).

Conclusion

Therapeutic strategy based on improving lactic acid and APACHE II would contribute to the outcome in patients with CrKP infection. Tigecycline combined with fosfomycin could reduce the 28-day mortality in patients with CrKP infection in developing country.

Keywords:

• carbapenem resistant Klebsiella pneumoniae
• lactic acid
• APACHE II score
• tigecycline
• fosfomycin
• mortality

Data Sharing Statement

The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Statement of Ethics

The study was conducted in accordance with the Declaration of Helsinki. This study was approved by the Research Ethics Committee of the Shenzhen Second People’s Hospital (20200422008). Considering the retrospective study design and depersonalization of the data, the Ethics Committee agreed to waive the requirement for written informed consent but required that the patients be informed of the study details during the telephone follow-up.

Disclosure

The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.