Risk Factors for Mortality and Outcomes in Hematological Malignancy Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections

Figures & data

Table 1 Clinical Characteristics of 129 Patients with CRKP Bloodstream Infection Carbapenem-Resistant Klebsiella Pneumonia

Variable	N = 129
Demographic information
Age	46.1 ± 13.8
Male sex	85 (65.9)
Patient characteristics
ANC < 500 (cells/mm^3)	120 (93.0)
ANC < 100 (cells/mm^3)	98 (76.0)
Days of ANC < 500 (cells/mm^3)	11 (7.0–19.0)
ANC < 500 (cells/mm^3) at discharge	98 (76.0)
HSCT	10 (7.8)
Hematological malignancy
Acute lymphatic leukemia	17 (13.2)
Acute myeloid leukemia	77 (59.7)
Chronic myeloid leukemia	2 (1.6)
Myelodysplastic syndrome	15 (11.6)
Lymphoma	16 (12.4)
Multiple myeloma	2 (1.6)
ICU admission	93 (72.1)
PBS	3 (1.0–6.0)
Renal replacement therapy	4 (3.1)
Mechanical ventilation	70 (54.3)
Septic shock	86 (66.7)
Length of stay in ICU	1 (0–4.0)
Length of hospitalization	25 (18–39)
Length of hospitalization before the onset of BSI	20 (14.5–28.5)
Carbapenem exposure	120 (93.0)
Antimicrobial therapy
Quinolones	9 (7.0)
TMP/SMX	3 (2.3)
Fosfomycin	11 (8.5)
Aztreonam or β-lactam/β-lactamase inhibitors	17 (13.2)
Aminoglycosides	2 (1.6)
Carbapenems	107 (82.9)
Tigecycline	86 (66.7)
Polymyxin B	30 (23.3)
CAZ/AVI	7 (5.4)
Appropriate early antimicrobial treatment	94 (72.9)

Abbreviations: ANC, absolute neutrophil count; HSCT, hematopoietic stem cell transplantation; ICU, intensive care unit; TMP/SMX, trimethoprim-sulfamethoxazole; CAZ/AVI, ceftazidime-avibactam; PBS, Pitt bacteremia score.

Table 2 Antibiotic Susceptibility Characteristics of Klebsiella Pneumonia Isolates

Antibiotic (N)	S (%)	I (%)	R (%)
Colistin (120)	99.2	NA	0.8
Tigecycline (129)	87.6	3.1	9.3
Trimethoprim-sulfamethoxazole (128)	33.6	NA	66.4
Amikacin (129)	30.2	NA	69.8
Ciprofloxacin (129)	5.4	NA	94.6
Aztreonam (129)	2.3	NA	97.7

Abbreviation: NA, not applicable.

Figure 1 The isolation rate of CRKP during the study period.

Table 3 Univariate and Multivariate Cox Regression Analysis of Mortality of Patients with Carbapenem-Resistant Klebsiella Pneumonia Bloodstream Infection

Variable	Survivors (N = 25)	Non-survivors N = 104)	Univariate Analysis		Multivariate Analysis
			HR (95% CI)	p values	HR (95% CI)	p values
Demographic information
Age	44.0 ± 11.8	46.6 ± 14.2	1.008 (0.993–1.023)	0.294
Male sex	17 (68.0)	68 (65.4)	0.989 (0.660–1.481)	0.957
Patient characteristics
ANC < 500 (cells/mm^3)	23 (92.0)	97 (93.3)	1.426 (0.661–3.078)	0.365
ANC < 100 (cells/mm^3)	19 (76.0)	79 (76.0)	0.999 (0.637–1.568)	0.996
Days of ANC < 500 (cells/mm^3)	12 (8.0–19.0)	11 (7.0–18.8)	0.993 (0.977–1.011)	0.452
ANC < 500 (cells/mm^3) at discharge	3 (12.0)	95 (91.3)	8.665 (4.256–17.642)	< 0.001	6.386 (3.074–13.266)	< 0.001
HSCT	5 (20.0)	5 (4.8)	0.499 (0.203–1.227)	0.130
Hematological malignancy
Acute lymphatic leukemia	3 (12.0)	14 (13.5)	0.921 (0.524–1.620)	0.776
Acute myeloid leukemia	17 (68.0)	60 (57.7)	0.786 (0.532–1.160)	0.225
Chronic myeloid leukemia	0 (0)	2 (1.9)	1.995 (0.489–8.137)	0.336
Myelodysplastic syndrome	2 (8.0)	13 (12.5)	1.536 (0.858–2.749)	0.149
Lymphoma	2 (8.0)	14 (13.5)	1.269 (0.723–2.230)	0.407
Multiple myeloma	1 (4.0)	1 (1.0)	0.559 (0.078–4.008)	0.562
ICU admission	7 (28.0)	86 (82.7)	3.338 (1.984–5.618)	< 0.001	1.834 (1.065–3.157)	0.029
PBS	1 (0–1.0)	4 (1.0–6.8)	1.223 (1.169–1.301)	< 0.001	1.185 (1.118–1.255)	< 0.001
RRT	0 (0)	4 (3.8)	1.879 (0.689–5.129)	0.218
Mechanical ventilation	0 (0)	70 (67.3)	3.494 (2.255–5.412)	< 0.001
Septic shock	4 (16.0)	82 (78.8)	3.680 (2.256–6.002)	< 0.001
ICU LOS	0 (0–4.0)	1.0 (1.0–4.0)	0.998 (0.981–1.015)	0.836
Length of hospitalization	41 (27.5–51.0)	23 (18.0–35.0)	0.978 (0.965–0.991)	0.001
Length of hospitalization before the onset of BSI	22 (10.0–27.0)	19.5 (15.0–30.0)	1.007 (0.995–1.020)	0.229
Carbapenem exposure	23 (92.0)	97 (93.3)	1.115 (0.518–2.402)	0.781
Antimicrobial therapy
Quinolones	3 (12.0)	6 (5.8)	0.614 (0.269–1.401)	0.247
TMP/SMX	2 (8.0)	1 (1.0)	0.280 (0.039–2.010)	0.206
Fosfomycin	0 (0)	11 (10.6)	1.542 (0.821–2.894)	0.178
Aztreonam or β-lactam/β-lactamase inhibitors	5 (20.0)	12 (11.5)	0.821 (0.449–1.500)	0.521
Aminoglycosides	1 (4.0)	1 (1.0)	0.379 (0.053–2.721)	0.335
Carbapenems	18 (72.0)	89 (85.6)	1.456 (0.841–2.522)	0.180
Tigecycline	17 (68.0)	69 (66.3)	0.802 (0.533–1.206)	0.289
Polymyxin B	8 (32.0)	22 (21.2)	0.637 (0.397–1.021)	0.061
CAZ/AVI	6 (24.0)	1 (1.0)	0.085 (0.012–0.608)	0.014
Appropriate early antimicrobial treatment	21 (84.0)	73 (70.2)	0.553 (0.361–0.846)	0.006

Abbreviations: ANC, absolute neutrophil count; HSCT, hematopoietic stem cell transplantation; ICU, intensive care unit; PBS, Pitt bacteremia score; RRT, renal replacement therapy; LOS, length of stay; BSI, bloodstream infection; CAZ/AVI, ceftazidime-avibactam; TMP/SMX, trimethoprim -sulfamethoxazole; CAZ/AVI, ceftazidime-avibacta.

Figure 2 Receiver operating characteristic (ROC) curve of Pitt bacteremia score (PBS).

Figure 3 Kaplan-Meier survival estimates among patients with (A) PBS≥2 and PBS<2, (B) different antimicrobial regimen.