Clinical Outcomes, Microbiological Characteristics and Risk Factors for Difficult-to-Treat Resistance to Klebsiella pneumoniae Infection

Figures & data

Table 1 Clinical Characteristics of the Patients with DTR vs Non-DTR Klebsiella pneumoniae

Clinical Characteristics	DTR (n=50)	Non-DTR (n=50)	P value
Basic demographics
Age	79.54±12.22	75.26±10.75	0.066
Male	29(58.0%)	31(62.0%)	0.683
Medical history
Diabetes	18(36.0%)	16(32.0%)	0.673
Pulmonary disease	13(26.0%)	14(28.0%)	0.822
Cardiovascular disease	46(92.0%)	36(72.0%)	0.009
Cerebrovascular disease	36(72.0%)	20(40.0%)	0.001
Digestive disease	21(42.0%)	19(38.0%)	0.683
Urinary disease	27(54.0%)	15(30.0%)	0.015
Cancer	8(16.0%)	8(16.0%)	1.000
CCI^a	3.84±1.56	2.48±1.45	0.000
Surgery within 3 months	2(4.0%)	3(6.0%)	1.000
Antibiotics exposure within 90 days	49(98.0%)	28(56.0%)	0.000
Usage of invasive catheters	50(100.0%)	26(52.0%)	0.000
Urinary catheter	45(90.0%)	19(38.0%)	0.000
Gastrostomy tube	45(90.0%)	17(34.0%)	0.000
Endotracheal tube	15(30.0%)	3(6.0%)	0.002
Central intravenous catheter	33(66.0%)	6(12.0%)	0.000
Drainage tube	12(24.0%)	6(12.0%)	0.118
Metastatic infection	18(36.0%)	4(8.0%)	0.001
Infection type
Hospital acquired infection	50(100.0%)	36(72.0%)	0.000
Community acquired infection	0(0.0%)	14(28.0%)	0.000
Laboratory examination
Red blood cell	2.87±0.82	3.79±0.69	0.000
Hemoglobin	90.14±24.62	114.90±20.49	0.000
White blood cell	9.6704±4.77709	10.9890±5.80403	0.218
Platelet	170.70±105.19	215.62±93.65	0.026
NEU%^b	77.464±14.9145	78.956±18.0857	0.270
Total protein	62.46±7.737	64.76±9.502	0.201
ALbumin	30.992±4.5367	32.950±5.6690	0.062
Hematocrit	0.70±3.00	0.35±0.06	0.000
Vasoactive drugs after Kp detection	11(22.0%)	6(12.0%)	0.183
Admitted to the ICU^c	22(44.0%)	5(10.0%)	0.000
Mechanical ventilation after Kp detection	13(26.0%)	5(10.0%)	0.037
SOFA^d	6.12±5.85	1.98±2.53	0.000
30-day mortality	19(38.0%)	4(8.2%)	0.000

Notes: Bold text: P value<0.05. ^cPatients infected kp were then transferred to the ICU.

Abbreviations: ^aCCI, Charlson comorbidity index; ^bNEU%, Neutrophil percentage; ^dSOFA, sequential organ failure assessment.

Figure 1 (A) Department distribution of the DTR-Kp-infected patients. (B) Sample type distribution of the DTR-Kp strains. (C) Resistance category distribution of all the enrolled Kp isolates.

Abbreviations: DTR, difficult-to-treat resistance; MDR, multidrug resistance; CR, carbapenem resistance; ESCR, extended-spectrum cephalosporin resistance; FQR, fluoroquinolone resistance.

Figure 2 Percentage of the hypervirulent Klebsiella pneumoniae (hvKp) strains among the identified DTR-Kp strains from January 2020 to March 2021.

Figure 3 Genomic distribution of the DTR Klebsiella pneumoniae strains. Red: antimicrobial resistance genes. Blue: Virulence genes.

Figure 4 Kaplan–Meier curves for all-cause 30-day mortality. Statistical significance was determined by the Log rank test.

Table 2 Risk Factors for Death

Variable	Univariate	P value	Multivariate	P value
	OR^a (95% CI^b)		OR (95% CI)
DTR	6.895(2.137–22.244)	0.001	4.196(1.089–16.173)	0.037
Usage of invasive catheters	8.963(1.137–70.634)	0.037	2.796(0.267–29.245)	0.391
Mechanical ventilation	3.520(1.189–10.424)	0.023	2.580(0.809–8.223)	0.109

Note: Bold text: P value<0.05.

Abbreviations: ^aOR, odds ratio; ^bCI, confidence interval.

Table 3 Risk Factors for DTR-Kp Infection

Variable	Univariate	P value	Multivariate	P value
	OR^a (95% CI^b)		OR (95% CI)
Cardiovascular disease	4.472(1.355–14.755)	0.014	1.716(0.436–6.753)	0.440
Cerebrovascular disease	3.857(1.670–8.911)	0.002	2.780(1.109–6.969)	0.029
Urinary disease	2.739(1.204–6.230)	0.016	1.906(0.760–4.778)	0.169
CCI	1.878(1.359–2.595)	0.000	1.584(1.117–2.245)	0.010

Note: Bold text: P value<0.05.

Abbreviations: ^aOR, odds ratio; ^bCI, confidence interval.