Clinical and Microbiological Prognostic Factors of in-Hospital Mortality Caused by Hypervirulent Klebsiella pneumoniae Infections: A Retrospective Study in a Tertiary Hospital in Southwestern China

Figures & data

Figure 1 Flow chart for study inclusion.

Abbreviations: KP, Klebsiella pneumoniae; HvKP, hypervirulent Klebsiella pneumoniae.

Table 1 Clinical Characteristics of Survivor and Non-Survivor Patients with hvKP

Clinical Characteristic	Total (n=135)	Survivors (n=119)	Non-Survivors (n=16)	p-value^a
Age, mean ± SD, years	60.4±17.1	59.5±16.5	67.4±20.7	0.082
Male	87(64.4)	75(63.0)	12(75.0)	0.508
Female	48(35.6)	44(37.0)	4(25.0)	0.508
Nosocomial infections	72(53.3)	61(51.3)	11(68.8)	0.188
Community-acquired infections	63(46.7)	58(48.8)	5(31.3)	0.188
Admission to ICU	52(38.5)	41(34.5)	11(68.8)	0.008
Post-culture length of hospital stay, median (IQR), days	4(1–13)	4(1–13)	10(2–26)	0.107
Total length of hospital stay, median (IQR), days	23(13–42)	23(13–37)	18(9–105)	0.878
Underlying diseases
Hypertension	44(32.6)	36(30.3)	8(50.0)	0.114
Diabetes mellitus	48(35.6)	42(35.3)	6(37.5)	0.863
Malignancy	31(23.0)	25(21.0)	6(37.5)	0.141
Tuberculosis	4(3.0)	3(2.5)	1(6.3)	0.981
Cardiovascular disease	34(25.2)	28(23.5)	6(37.5)	0.227
Cerebral vascular disease	37(27.4)	30(25.2)	7(43.8)	0.119
Respiratory diseases	85(63.0)	76(63.9)	9(56.3)	0.554
Digestive system diseases	86(63.7)	74(62.2)	12(75.0)	0.469
Chronic kidney diseases	53(39.3)	46(38.7)	7(43.8)	0.695
Hematological diseases	9(6.7)	8(6.7)	1(6.3)	>0.999
Endocrine diseases	47(34.8)	40(33.6)	7(43.8)	0.424
Peripheral vascular diseases	23(17.0)	20(16.8)	3(18.8)	>0.999
Immunosuppression	44(32.6)	36(30.3)	8(50.0)	0.114
Infection source
Skin and soft tissue	10(7.4)	8(6.7)	2(12.5)	0.749
Respiratory tract	65(48.1)	58(48.7)	7(43.8)	0.708
Intra-abdomen	7(5.2)	6(5.0)	1(6.3)	0.595
Biliary tract	7(5.2)	7(5.9)	0	>0.999
Urinary tract	15(11.1)	13(10.9)	2(12.5)	>0.999
Catheter	5(3.7)	5(4.2)	0	>0.999
Primary bacteremia	26(19.3)	22(18.5)	4(25.0)	0.777
Antimicrobial exposure within 4weeks
Penicillin	27(20.0)	23(19.3)	4(25.0)	0.594
Cephalosporins	90(66.7)	78(65.5)	12(75.0)	0.451
Carbapenem	40(29.6)	33(27.7)	7(43.8)	0.188
Aminoglycosides	1(0.7)	1(0.8)	0	>0.999
Fluoroquinolone	21(15.6)	17(14.3)	4(25.0)	0.458
Tetracycline	2(1.5)	1(0.8)	1(6.3)	0.119
Macrolides	1(0.7)	1(0.8)	0	>0.999
Metronidazole	18(13.3)	16(13.4)	2(12.5)	>0.999
Glycopeptide	10(7.4)	8(6.7)	2(12.5)	0.749
Tigecycline	4(3.0)	3(2.5)	1(6.3)	0.968

Notes: Data are expressed as no. (%) unless specified otherwise. Bold represents statistical differences (p< 0.05).

Abbreviations: SD, standard deviation; IQR, interquartile range; ICU, intensive care unit.

Table 2 Bacterial Characteristics of hvKP in Survivor and Non-Survivor Groups

Variables	Total (n=135)	Survivors (n=119)	Non-Survivors (n=16)	p-value^a
Capsule types
K1	43(31.9)	40(33.6)	3(18.8)	0.231
K2	34(25.2)	31(26.1)	3(18.8)	0.745
K5	4(3.0)	4(3.4)	0	>0.999
K20	5(3.7)	4(3.4)	1(6.3)	>0.999
K54	2(1.5)	1(0.8)	1(6.3)	0.562
K57	11(8.1)	9(7.6)	2(12.5)	0.848
Multi-locus sequence types
ST23	37(27.4)	35(29.4)	2(12.5)	0.26
ST86	10(7.4)	10(8.4)	0	0.607
ST65	7(5.2)	7(5.9)	0	>0.999
ST412	6(4.4)	5(4.2)	1(6.3)	>0.999
ST380	5(3.7)	5(4.2)	0	>0.999
ST29	5(3.7)	4(3.4)	1(6.3)	>0.999
Allantoin metabolism
alls	48(35.6)	44(37.0)	4(25.0)	0.508
Adhesin
fimH	125(92.6)	109(91.6)	16(100.0)	0.607
mrkD	127(94.1)	113(95.0)	14(87.5)	0.534
Biosynthesis of lipopolysaccharide
ycfM	133(98.5)	117(98.3)	16(100.0)	>0.999
wabG	105(77.8)	94(79.0)	11(68.8)	0.355
Fucose synthesis
wcaG	100(74.1)	92(77.3)	8(50.0)	0.26
Mucoviscosity
magA	44(32.6)	41(34.5)	3(18.8)	0.33
PrmpA	118(87.4)	107(89.9)	11(68.8)	0.017
PrmpA2	99(73.3)	90(75.6)	9(56.3)	0.1
Siderophore
entB	134(99.3)	118(99.2)	16(100.0)	>0.999
kfu	68(50.4)	60(50.4)	8(50.0)	0.975
iroB	95(70.4)	84(70.6)	11(68.8)	0.880
iroN	83(61.5)	69(58.0)	14(87.5)	0.023
irp-1	116(85.9)	103(86.6)	13(81.3)	0.849
irp-2	116(85.9)	103(86.6)	13(81.3)	0.849
iutA	104(77.0)	93(78.2)	11(68.8)	0.401
ybtS	93(68.9)	82(68.9)	11(68.8)	0.990
Putative transporter
peg-344	131(97.0)	116(97.5)	15(93.8)	0.968

Notes: Data are expressed as no. (%). Bold represents statistical differences (p< 0.05).

Table 3 Antimicrobial Resistance of hvKP in Survivor and Non-Survivor Groups

Antimicrobial Agents	Total (n=135)	Survivors (n=119)	Non-Survivors (n=16)	p-value^a
Piperacillin/tazobactam	5(3.7)	3(2.5)	2(12.5)	0.201
Ampicillin/sulbactam	24(17.8)	18(15.1)	6(37.5)	0.028
Ceftriaxone	19(14.1)	15(12.6)	4(25.0)	0.339
Ceftazidime	11(8.1)	8(6.7)	3(18.8)	0.244
Cefoperazone/sulbactam	4(3.0)	3(2.5)	1(6.3)	0.968
Cefepime	11(8.1)	7(5.9)	4(25.0)	0.033
Cefoxitin	11(8.1)	9(7.6)	2(12.5)	0.848
Ertapenem	5(3.7)	3(2.5)	2(12.5)	0.201
Imipenem	5(3.7)	3(2.5)	2(12.5)	0.201
Meropenem	4(3.0)	3(2.5)	1(6.3)	0.968
Tobramycin	5(3.7)	3(2.5)	2(12.5)	0.201
Amikacin	4(3.0)	2(1.7)	2(12.5)	0.107
Levofloxacin	9(6.7)	6(5.0)	3(18.8)	0.126
Aztreonam	13(9.6)	9(7.6)	4(25.0)	0.049
Sulfamethoxazole	19(14.1)	15(12.6)	4(25.0)	0.339
Minocycline	15(11.1)	13(10.9)	2(12.5)	>0.999
Furazolidone	5(3.7)	4(3.4)	1(6.3)	0.473
Tigecycline	1(0.7)	1(0.8)	0	>0.999

Notes: Data are expressed as no. (%). Bold represents statistical differences (p< 0.05).

Table 4 Clinical and Microbiological Characterization of CR-hvKP Isolates

Strain	Genotype	MIC (mg/L)															ST	Prognosis^a
		TZP	CRO	CAZ	SCF	FEP	FOX	ETP	IMP	MEM	TOB	AMK	LEV	ATM	SXT	TGC
KP-1	CTX-9-group, TEM, KPC-2	≥128	≥64	64	≥64	64	≥64	≥8	16	16	≥16	≥64	≥8	64	≥320	1	25	death
KP-6	TEM, KPC-2	≥128	32	≥64	≥64	≥64	≥64	≥8	128	128	≤1	≤2	≥8	≥64	≥320	2	11	survive
KP-10	CTX-9-group, TEM, KPC-2	≥128	≥64	≥64	≥64	≥64	≥64	≥8	128	128	≥16	≥64	≥8	≥64	≥320	2	11	survive
KP-12	TEM, KPC-2	≥128	≥64	≥64	≥64	≥64	≥64	≥8	128	128	≥16	≥64	≥8	≥64	≥320	2	11	survive
KP-103	CTX-9-group, SHV, TEM, KPC-2	≥128	≥64	≥64	≥64	≥32	≥64	≥8	64	64	≥16	≥64	≥8	≥64	≤20	2	2856	survive

Notes: The prognosis is judged by the state at the time of discharge.

Abbreviations: TZP, piperacillin/tazobactam; CRO, ceftriaxone; CAZ, ceftazidime; SCF, cefoperazone/sulbactam; FEP, cefepime; FOX, cefoxitin; ETP, ertapenem; IMP, imipenem; MEM, meropenem; TOB, tobramycin; AMK, amikacin; LEV, levofloxacin; ATM, aztreonam; SXT, sulfamethoxazole; TGC, tigecycline.

Table 5 Prognostic Factors Associated with in-Hospital Mortality of Patients with hvKP Infections

	Univariable Analysis		Multivariable Analysis
Variables	OR (95% CI)	P-value	OR (95% CI)	P-value^a
Age	NA	0.082
Admission to ICU	4.185(1.362–12.862)	0.008	3.452(1.052–11.329)	0.041
Resistant to Cefepime	5.333(1.362–20.886)	0.033
Resistant to Aztreonam	4.074(1.088–15.250)	0.049
Resistant to SAM	3.367(1.088–10.417)	0.028
iroN	5.072(1.103–23.324)	0.023	9.278(1.654–52.035)	0.011
prmpA	0.247(0.073–0.831)	0.017

Notes: Bold represents statistical differences (p< 0.05).

Abbreviations: OR, odds ratio; CI, confidence interval; NA, not available; ICU, intensive care unit; SAM, ampicillin/sulbactam.