Clinical Characteristics and Risk Factors for Critically Ill Patients with Carbapenem-Resistant Klebsiella pneumonia e (CrKP): A Cohort Study from Developing Country

Ying-Yi Luan; Yan-Hong Chen; Xue Li; Zhi-Peng Zhou; Jia-Jia Huang; Zhen-Jia Yang; Jing-Jing Zhang; Ming Wu

doi:10.2147/IDR.S343489

Clinical Characteristics and Risk Factors for Critically Ill Patients with Carbapenem-Resistant Klebsiella pneumonia e (CrKP): A Cohort Study from Developing Country

Infect Drug Resist. 2021 Dec 20:14:5555-5562. doi: 10.2147/IDR.S343489. eCollection 2021.

Authors

Ying-Yi Luan^#¹, Yan-Hong Chen^#², Xue Li³, Zhi-Peng Zhou², Jia-Jia Huang^{2

4}, Zhen-Jia Yang^{2

4}, Jing-Jing Zhang^{2

5}, Ming Wu^{2

4

6}

Affiliations

¹ Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, People's Republic of China.
² Department of Critical Care Medicine and Hospital Infection Prevention and Control, Shenzhen Second People`s Hospital & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, 518035, People's Republic of China.
³ Department of Emergency, the Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, People's Republic of China.
⁴ Shantou University Medical College, Shantou, 515041, People's Republic of China.
⁵ Department of Critical Care Medicine, Pingshan District People's Hospital of Shenzhen, Shenzhen, 518118, People's Republic of China.
⁶ Guangxi University of Chinese Medicine, Nanning, 530200, People's Republic of China.

^# Contributed equally.

Abstract

Background: Increasing evidence indicates carbapenem-resistant Klebsiella pneumoniae (CrKP) is increasingly prevalent in intensive care unit (ICU), but its clinical characteristics and risk factors remain unknown.

Aim: The aim of the present study was to evaluate clinical characteristics, risk factors in critically ill patients with CrKP infection.

Methods: A retrospective study was included in patients from January 2013 to October 2019. Clinical data were collected from CrKP patients on the day of specimen collection admitted to ICU. Multivariable logistic regression was used for risk factors. Receiver operating curve (ROC) and the area under the curve (AUC) with DeLong method of MedCalc software were used. Two-way repeated-measures ANOVA analysis was used to analyze the characteristics of independent risk factors over time.

Findings: A total of 147 adult patients with CrKP were screened, among them, 89 (median age 64.0 years, 66 (74.15%) males) patients with CrKP were finally included, of which 38 patients (42.7%) were non-survival group. Multivariate logistic regression analysis indicated that lactic acid (OR3.04 95% CI 1.38-6.68, P = 0.006), APACHE II score (OR 1.20, 95% CI 1.09-1.33, P < 0.001), tigecycline combined with fosfomycin treatment (OR0.15, 95% CI 0.04-0.65, P = 0.011) are independent risk factors for 28-day mortality in patients with CRKP infection (P<0.05). Combined lactic acid with APACHE II score could predict 28-day mortality, of which AUC value was 0.916 (95% CI, 0.847-0.985), with sensitivity 0.76 and specificity 0.98. ANOVA analysis showed that APACHE II score and lactic acid between the two groups at three-time points were statistically significant, which interactive with time and showed an upward and downward trend with time (P < 0.05).

Conclusion: Therapeutic strategy based on improving lactic acid and APACHE II would contribute to the outcome in patients with CrKP infection. Tigecycline combined with fosfomycin could reduce the 28-day mortality in patients with CrKP infection in developing country.

Keywords: APACHE II score; carbapenem resistant Klebsiella pneumoniae; fosfomycin; lactic acid; mortality; tigecycline.

Grants and funding

This work was supported by grants from the Sanming Project of Medicine in Shenzhen (SZSM20162011), the National Natural Science Foundation of China (Nos. 81873943), Shenzhen Science and Technology Innovation Commission (JCYJ20190806163603504), and Shenzhen Second People’s Hospital Clinical Research Fund of Guangdong Province High-level Hospital Construction Project (Grant No20173357201815, No20193357003, No 20203357014).