The Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infection: A Single-Center Chinese Retrospective Study

Figures & data

Table 1 Risk Factors for CRKP Infection

Risk Factors [n (%)]		CRKP (n=95)	CSKP (n=238)	Univariable Analysis		Multivariate Analysis
				OR (95% CI)	P value	OR (95% CI)	P value
Age (Year)
<60		12	43	1.000
60–70		23	61	1.351 (0.607–3.006)	0.460
70–80		32	77	1.489 (0.696–3.188)	0.304
≥80		28	57	1.760 (0.804–3.854)	0.155
Sex
Male		55	152	1.000
Female		40	86	1.285 (0.791–2.089)	0.310
APACHE II score
< 18		13	60	1.000		1.000
18–20		17	50	1.569 (0.695–3.541)	0.276	1.028 (0.262–3.014)	0.453
20–22		20	41	2.251 (1.008–5.027)	0.045	1.941 (0.730–4.228)	0.327
22–24		22	46	2.207 (1.006–4.844)	0.046	2.102 (0.804–4.822)	0.121
>24		23	41	2.589 (1.178–5.691)	0.016	2.662 (0.903–5.164)	0.088
Concomitant diseases
Lung disease	No	49	137	1.000
	Yes	46	101	1.273 (0.790–2.053)	0.321
Cardiac dysfunction	No	66	176	1.000
	Yes	29	62	1.247 (0.739–2.106)	0.408
Renal dysfunction	No	55	171	1.000		1.000
	Yes	40	67	1.856 (1.131–3.047)	0.014	1.642 (0.875–4.823)	0.104
Neurological disease	No	81	215	1.000
	Yes	14	23	1.616 (0.793–3.292)	0.183
Liver disease	No	76	180	1.000
	Yes	19	58	0.776 (0.433–1.390)	0.393
Diabetes mellitus	No	60	186	1.000		1.000
	Yes	35	52	2.087 (1.243–3.503)	0.005	1.805 (0.742–5.721)	0.103
Hypoalbuminemia	No	42	122	1.000
	Yes	53	116	1.327 (0.823–2.141)	0.245
Tumor	No	83	204	1.000
	Yes	12	34	0.867 (0.428–1.757)	0.693
Septicemia	No	38	120	1.000
	Yes	57	118	1.525 (0.941–2.472)	0.086
Antibiotics application before K.pn infection
Fluoroquinolones	No	40	141	1.000		1.000
	Yes	55	97	1.999 (1.234–3.238)	0.005	2.107 (0.871–5.105)	0.092
2nd generation  cephalosporins	No	55	125	1.000
	Yes	40	113	0.805 (0.498–1.300)	0.374
3rd generation  cephalosporins	No	66	193	1.000		1.000
	Yes	29	45	1.885 (1.094–3.247)	0.021	1.846 (0.825–6.292)	0.156
Amikacin	No	78	209	1.000
	Yes	17	29	1.571 (0.818–3.017)	0.173
Carbapenems	No	42	165	1.000		1.000
	Yes	53	73	2.852 (1.748–4.655)	<0.001	4.244 (1.637–12.623)	<0.001
Cefoperazone plus  sulbactam	No	58	190	1.000		1.000
	Yes	37	48	2.525 (1.501–4.247)	<0.001	2.868 (0.903–6.128)	0.068
Glycopeptides	No	49	170	1.000		1.000
	Yes	46	68	2.347 (1.436–3.834)	0.001	3.528 (0.811–7.391)	0.101
Using more than 3  antibiotics	< 7 days	44	177	1.000		1.000
	≥ 7 days	51	61	3.363 (2.045–5.530)	<0.001	5.412 (2.124–10.101)	<0.001
Surgery
No		68	190	1.000
Yes		27	48	1.572 (0.910–2.716)	0.104
Invasive procedures
Deep venous  catheterization	No	35	144	1.000		1.000
	Yes	60	94	2.626 (1.607–4.292)	<0.001	2.242 (0.905–6.821)	0.093
Tracheotomy	No	34	150	1.000		1.000
	Yes	61	88	3.058 (1.864–5.018)	<0.001	3.527 (2.131–7.511)	<0.001
Mechanical ventilation	No	28	142	1.000		1.000
	Yes	67	96	3.539 (2.122–5.903)	<0.001	2.983 (0.842–6.431)	0.089
Indwelling urethral  catheter	No	27	112	1.000		1.000
	Yes	68	126	2.239 (1.340–3.741)	0.002	2.488 (0.724–5.418)	0.105
Indwelling gastric tube	No	55	142	1.000
	Yes	40	96	1.076 (0.664–1.743)	0.767
Hospital stay
< 14 days		49	145	1.000
≥ 14 days		46	93	1.464 (0.906–2.364)	0.118
ICU stay
< 3 days		31	145	1.000		1.000
≥ 3 days		64	93	3.219 (1.949–5.316)	<0.001	5.211 (1.882–10.663)	<0.001

Abbreviations: CRKP, carbapenem-resistant Klebsiella pneumoniae; CSKP, carbapenem-susceptible Klebsiella pneumoniae; K.pn, Klebsiella pneumoniae; APACHE II, Acute Physiology and Chronic Health Evaluation II; ICU, intensive care unit.

Table 2 Risk Factors for Death in Patients with CRKP Infection

Risk Factors [n (%)]		Death (n=28)	Survival (n=60)	Univariable Analysis		Multivariate Analysis
				OR (95% CI)	P value	OR (95% CI)	P value
Age (Year)
< 60		2	28	1.000		1.000
60–70		4	16	3.500 (0.576–21.282)	0.155	2.777 (0.582–17.782)	0.109
70–80		10	9	15.556 (2.859–84.623)	<0.001	8.692 (1.822–67.641)	<0.001
≥80		12	7	24.000 (4.337–132.801)	<0.001	15.721 (2.521–94.630)	<0.001
Sex
Male		14	38	1.000
Female		14	22	1.727 (0.697–4.283)	0.236
APACHE II score
< 18		1	20	1.000		1.000
18–20		3	17	3.529 (0.335–37.146)	0.269	2.132 (0.631–29.247)	0.154
20–22		4	9	8.889 (0.866–91.199)	0.059	9.132 (0.898–78.238)	0.081
22–24		9	8	22.500 (2.437–207.732)	0.001	16.751 (0.856–178.821)	0.061
>24		11	6	36.667 (3.899–344.837)	<0.001	19.739 (0.888–215.561)	0.068
Concomitant diseases
Lung disease	No	10	36	1.000		1.000
	Yes	18	24	2.700 (1.066–6.841)	0.034	1.536 (0.775–5.834)	0.087
Cardiac dysfunction	No	16	45	1.000
	Yes	12	15	2.250 (0.871–5.815)	0.091
Renal dysfunction	No	10	43	1.000		1.000
	Yes	18	17	4.553 (1.751–11.837)	0.001	1.785 (1.224–8.327)	0.015
Neurological  disease	No	25	53	1.000
	Yes	3	7	0.909 (0.217–3.811)	0.896
Liver disease	No	23	48	1.000
	Yes	5	12	0.870 (0.274–2.762)	0.813
Diabetes mellitus	No	14	44	1.000		1.000
	Yes	14	16	2.750 (1.078–7.012)	0.031	2.662 (0.879–7.152)	0.088
Hypoalbuminemia	No	16	24	1.000
	Yes	12	36	0.500 (0.201–1.241)	0.133
Tumor	No	23	54	1.000
	Yes	5	6	1.957 (0.542–7.060)	0.299
Septicemia	No	14	39	1.000
	Yes	14	21	1.857 (0.747–4.619)	0.181
Antibiotics use after K.pn infection
Fluoroquinolones	No	8	28	1.000
	Yes	20	32	2.188 (0.834–5.737)	0.108
2nd generation  cephalosporins	No	19	32	1.000
	Yes	9	28	0.541 (0.211–1.388)	0.199
3rd generation  cephalosporins	No	16	47	1.000		1.000
	Yes	12	13	2.712 (1.030–7.140)	0.040	2.886 (0.711–8.175)	0.101
Amikacin	No	24	50	1.000
	Yes	4	10	0.833 (0.237–2.931)	0.776
Carbapenems	No	7	32	1.000		1.000
	Yes	21	28	3.429 (1.268–9.268)	0.013	2.326 (0.886–13.974)	0.079
Cefoperazone plus  sulbactam	No	13	40	1.000
	Yes	15	20	2.308 (0.923–5.770)	0.071
Glycopeptides	No	18	29	1.000
	Yes	10	31	0.520 (0.206–1.309)	0.162
Using more than 3  antibiotics	< 7 days	5	32	1.000		1.000
	≥ 7 days	23	28	5.257 (1.764–15.668)	0.002	5.042 (0.940–15.125)	0.070
Surgery before admission
No		19	45
Yes		9	15	1.421 (0.531–3.806)	0.483
Invasive procedures
Deep venous  catheterization	No	5	28	1.000		1.000
	Yes	23	32	4.025 (1.351–11.996)	0.009	2.524 (0.798–10.321)	0.096
Tracheotomy	No	5	25	1.000		1.000
	Yes	23	35	3.286 (1.099–9.820)	0.028	2.149 (1.103–10.262)	0.005
Mechanical  ventilation	No	10	37	1.000		1.000
	Yes	18	23	2.896 (1.140–7.353)	0.023	1.782 (0.852–4.931)	0.094
Indwelling urethral  catheter	No	9	15	1.000
	Yes	19	45	0.704 (0.263–1.885)	0.483
Indwelling gastric  tube	No	17	33	1.000
	Yes	11	27	0.791 (0.317–1.971)	0.614
ICU stay
< 3 days		9	49	1.000		1.000
≥ 3 days		19	11	9.404 (3.364–26.287)	<0.001	3.646 (2.101–19.126)	<0.001

Abbreviations: CRKP, carbapenem-resistant Klebsiella pneumoniae; CSKP, carbapenem-susceptible Klebsiella pneumoniae; K.pn, Klebsiella pneumoniae; APACHE II, Acute Physiology and Chronic Health Evaluation II; ICU, intensive care unit.