Clinical Characteristics and Risk Factors for Bloodstream Infection Due to Carbapenem-Resistant Klebsiella pneumoniae in Patients with Hematologic Malignancies

Figures & data

Figure 1 Flowchart of the study design.

Table 1 Clinical Characteristics of 22 Patients with CRKP BSI

	N or Median	%
Number of patients	22
Gender
Male	15	68.2
Female	7	31.8
Average age	45
Diagnosis
AML	14	63.6
ALL	5	22.7
MDS	1	4.5
Multiple Myeloma	1	4.5
Others	1	4.5
Severe neutropenia after BSI	18	81.8
PBS>4	3	13.6
Pneumonia	13	59.1
Septic shock	13	59.1
Appropriate initial anti-infection therapy	16	72.7
Anti-CRKP therapeutic regimen
Tigecycline	12	54.5
Polymyxin B	0	0
Tigecycline + Polymyxin B	7	31.8
None of the above	3	13.6

Table 2 Comparison of Clinical Characteristics Between the Survival Group and the Non-Survival Group

	Survivors		Non-Survivors
	N or Median	% or (IQI)	N or Median	% or (IQI)
Number of patients	5	22.7	17	77.3
Gender
Male	4	80	11	64.7
Female	1	20	6	35.3
Age	38	26–50	47	33–60
Diagnosis
AML	4	80	10	58.8
ALL	1	20	4	23.5
MDS	0	0	1	5.9
Multiple Myeloma	0	0	1	5.9
Others	0	0	1	5.9
Severe neutropenia after BSI	4	80	14	82.4
PBS>4	0	0	3	17.6
Pneumonia	2	40	11	64.7
Septic shock	0	0	13	76.5
Appropriate initial anti-infection therapy	5	100	11	64.7
Anti-CRKP therapeutic regimen
Tigecycline	3	60	9	52.9
Polymyxin B	0	0	0	0
Tigecycline+ Polymyxin B	2	40	5	29.4
None of the above	0	0	3	17.7

Figure 2 Kaplan–Meier univariate survival estimates (A) PBS within 48 hours before or on the day of first positive blood culture; (B) anti-CRKP therapeutic regimen after the bloodstream infection.

Table 3 Comparison of Patients with and without CRKP Bloodstream Infection

	CRKP BSI		No CRKP BSI		P
	N or Median	% or (IQI)	N or Median	% or (IQI)
Number of patients	22	3	712	97
Male	15	62.8	411	57.7	0.33
Age	45	33–59	44	30–56	0.73
Diagnosis
AML	14	63.6	351	49.3	0.19
ALL	5	22.7	152	21.3	1.00
MDS	1	4.5	50	7	0.98
CLL/SLL	0	0	2	0.3	1.00
CML	0	0	2	0.3	1.00
CMML	0	0	5	0.7	1.00
Multiple Myeloma	1	4.5	50	7	0.98
Hodgkin Disease	0	0	4	0.5	1.00
NHL	0	0	87	12.2	0.16
Others	1	4.5	9	1.2	0.26
Leukemia Induction	5	22.7	136	19.1	0.88
HSCT	7	31.8	342	48	0.13
Autologous HSCT	0	0	56	7.9	0.52
Allogeneic HSCT	7	31.8	286	40.2	0.43
GVHD	3	13.6	102	14.3	1.00
CRKP Rectal Colonization	9	40.9	45	6.3	<0.001
Severe Neutropenia (ANC<100)	18	81.8	539	75.7	0.51
Days With ANC<100	7	4–11	7	2–12	0.86
GI Disturbance	7	31.8	293	41.2	0.38
Renal Insufficiency	1	4.5	15	2.1	0.39
Anti-anaerobic Antibiotic	11	50	368	51.7	0.88
Antibiotic Days of Therapy	2	0–12	3	0–11	0.55
3rd-4th-Generation Cephalosporin	9	40.9	423	59.4	0.08
Antibiotic Days of Therapy	0	0–10	5	0–11	0.37
Fluoroquinolone	10	45.5	399	56	0.33
Antibiotic Days of Therapy	0	0–8	6	0–10	0.16
Aminoglycoside	1	4.5	60	8.4	0.80
Antibiotic Days of Therapy	0	0–0	0	0–0	0.50
Glycopeptide	9	40.9	350	49.2	0.45
Antibiotic Days of Therapy	0	0–6	0	0–8	0.28
Carbapenem	16	72.7	595	83.6	0.18
Antibiotic Days of Therapy	8	0–16	10	5–16	0.41
Anti-CRKP Antibiotics
Tigecycline	5	22.7	175	24.6	0.84
Antibiotic Days of Therapy	0	0–2	0	0–0	0.86
Polymyxin B	1	4.5	12	1.7	0.33
Antibiotic Days of Therapy	0	0–0	0	0–0	0.31
ICU (within 30 days)	1	4.5	4	0.6	0.14
IMV (within 30 days)	1	4.5	3	0.4	0.12
Urinary Catheter (within 30 days)	2	9.1	21	3	0.15
PICC or CVC (within 30 days)	22	100	657	92.3	0.35

Table 4 Logistic Regression Analysis of Risk Factors for CRKP BSI Development

	OR (95% CI)	β-Value	Risk Score Point
CRKP rectal colonization	11.067 (4.43–27.644)	2.519	3
Severe neutropenia	4.095 (0.876–19.141)	0.945	1
IMV	18.444 (1.787–190.343)	3.708	4

Figure 3 Receiver-operator characteristic curve for CRKP score and CRKP BSI.

Figure 4 Antibiotic resistance rates of 22 CRKP strains.

Figure 5 Comparison of antibiotic resistance rates of CRKP between the survival group and the non-survival group.