Bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae: analysis of risk factors, treatment responses and mortality.

Abstract

Objective: Bloodstream infections (BSIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) are a serious threat to public health. In this study, it was aimed to evaluate the risk factors, treatment, length of hospitalisation and mortality of patients with BSI caused by CRKP.

Methods: Between October 2021 and October 2023, patients aged 18 years and older who were treated for BSI at Mersin University Faculty of Medicine Hospital and had pathogens identified as CRKP or carbapenem-sensitive Klebsiella pneumoniae (CSKP) were retrospectively reviewed and included in the study.

Results: Of the 107 patients with BSI included in the study, 66 (61.7%) had CRKP and 41 (38.3%) had CSKP. The risk factors associated with CRKP in BSIs were found to be acute renal failure (p = 0.048), mechanical ventilation (MV) (p = 0.042), post-earthquake period (p = 0.022) and use of carbapenem (p < 0.0005) and other beta-lactam antibiotics (p = 0.039). Mortality was significantly higher in BSIs caused by CRKP (80.3%/29.3%, p < 0.0005). In the CRKP group, intensive care unit follow-up (p = 0.020), intubation (p = 0.039), MV monitoring (p = 0.025) and concomitant pneumonia (p = 0.043) significantly increased mortality. There were no significant differences in treatment outcomes between ceftazidime-avibactam and carbapenem combinations (p > 0.05). In the CRKP group, the duration of treatment and hospital stay were significantly longer in patients who started treatment three days or later (p = 0.036/p = 0.011).

Conclusion: This study demonstrates that identifying risk factors for BSIs caused by CRKP and implementing early treatment protocols may lead to a reduction in treatment time and mortality rate.