Infect Chemother.  2021 Sep;53(3):528-538. 10.3947/ic.2021.0083.

Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemaseproducing K. pneumoniae and Escherichia coli bacteremia

• Seo H
• Bae S
• Kim MJ
• Chong YP
• Kim SH
• Lee SO
• Choi SH
• Kim YS
• Jung J

• KMID: 2521230
• DOI: http://doi.org/10.3947/ic.2021.0083

Abstract

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-producingK. 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.

Keyword

Klebsiella pneumoniaeCarbapenemase; Mortality; Klebsiella pneumoniae; Escherichia coli; Bacteremia