AUTHOR=Sun Xiangyuan , Zou Xiaocui , Zhou Boting , Yin Tao , Wang Ping 

TITLE=Comparison of bloodstream and non-bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae in the intensive care unit: a 9-year respective study

JOURNAL=Frontiers in Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1230721

DOI=10.3389/fmed.2023.1230721

ISSN=2296-858X

ABSTRACT=<sec id="sec1"><title>Background</title><p>Bloodstream infections (BSIs) caused by carbapenem-resistant <italic>Klebsiella pneumoniae</italic> (CRKP) have received much attention. However, few studies have identified risk factors for CRKP BSIs in comparison to CRKP non-bloodstream infections (non-BSIs). This study aimed to compare the epidemiology, risk factors, and outcomes of CRKP BSIs and CRKP non-BSIs.</p></sec><sec id="sec2"><title>Methods</title><p>We conducted a retrospective study of patients infected with CRKP in the ICU from January 2012 to December 2020. Clinical characteristics and outcomes were compared between CRKP BSIs and CRKP non-BSIs. Predictors associated with 28-day all-cause mortality in CRKP-infected patients were also evaluated.</p></sec><sec id="sec3"><title>Results</title><p>326 patients infected with CRKP were enrolled, including 96 patients with CRKP BSIs and 230 with CRKP non-BSIs. The rates of CRKP BSIs in CRKP infections were generally raised from 2012 (12.50%) to 2020 (45.76%). Multivariate logistic analysis indicated that the use of carbapenems within the prior 90 days was an independent risk factor for CRKP BSIs (<italic>p</italic> = 0.019). Compared to CRKP non-BSIs, CRKP isolates in the CRKP BSI group were found to be non-susceptible to more tested carbapenems (<italic>p</italic> = 0.001). Moreover, the CRKP BSI group exhibited a higher mortality rate (<italic>p</italic> = 0.036). The non-susceptibility of CRKP isolates to more tested carbapenems (<italic>p</italic> = 0.025), a high SOFA score (<italic>p</italic> = 0.000), and the use of antifungal drugs within the prior 90 days (<italic>p</italic> = 0.018) were significant factors for 28-day all-cause mortality in CRKP-infected patients.</p></sec><sec id="sec4"><title>Conclusion</title><p>The proportion of CRKP BSI increased progressively in CRKP-infected patients over 9 years. The use of carbapenems within the prior 90 days was an independent risk factor for the development of CRKP BSIs. The non-susceptibility of CRKP isolates to more tested carbapenems and a higher mortality rate were found in the CRKP BSI group.</p></sec>