Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemaseproducing K. pneumoniae and Escherichia coli bacteremia
Background: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales
bacteremia is associated with significant mortality; however, no optimal antibiotic strategy
is available. We aimed to evaluate the clinical outcomes according to the antibiotic regimens
and identify risk factors for mortality in patients with KPC-producing K. pneumoniae and
Escherichia coli bacteremia.
Materials and Methods: This retrospective cohort study included all adult patients with
monomicrobial bacteremia (KPC-producing K. pneumoniae or E. coli) between January 2011
and March 2021 at a 2,700-bed tertiary center.
Results: Ninety-two patients were identified; 7 with E. coli bacteremia, and 85 with K.
pneumoniae bacteremia. Thirty-day mortality was 38.0% (35/92). Non-survivors were more
likely to have had nosocomial infection (88.6% vs. 63.2%, P = 0.01), high APACHE II scores
(mean [interquartile range], 22.0 [14.0 - 28.0] vs. 14.0 [11.0 - 20.5], P <0.001), and septic
shock (51.4% vs. 26.3%, P <0.001) and less likely to have been admitted to the surgical ward
(5.7% vs. 22.8%, P = 0.04), undergone removal of eradicable foci (61.5% vs. 90.6%, P = 0.03),
and received appropriate combination treatment (57.1% vs. 78.9%, P = 0.03) than survivors.
No significant difference in mortality was observed according to combination regimens
including colistin, aminoglycoside, and tigecycline. In multivariable analysis, high APACHE II
scores (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.06 - 1.23, P <0.001),
and appropriate definitive treatment (aOR, 0.25; CI, 0.08 - 0.74, P = 0.01) were independent
risk factors for mortality.
Conclusion: High APACHE II scores and not receiving appropriate definitive treatment
were associated with 30-day mortality. Mortality did not significantly differ according to
combination regimens with conventional drugs such as aminoglycoside and colistin.
- 서현지; 배성만; 김민재; 정용필; 김성한; 이상오; 최상호; 김양수; 정지원
- Issued Date
- Klebsiella pneumoniae Carbapenemase; Mortality; Klebsiella pneumoniae; Escherichia coli; Bacteremia
- Infection & Chemotherapy
- Citation Volume
- Citation Number
- Citation Start Page
- Citation End Page
Appears in Collections:
- Medicine > Medicine
- Authorize & License
- Files in This Item:
Items in Repository are protected by copyright, with all rights reserved, unless otherwise indicated.