Clinical and Microbiological Characteristics of Bloodstream Infections due to CRKP.

Abstract

Background: Bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) often result in high mortality rates. This study aimed to explore the local epidemiology and risk factors of CRKP bloodstream infections, characterize the resistance and virulence genes of CRKP isolates in this region of China, and identify the circulating hypervirulent Klebsiella pneumoniae strains locally.

Methods: In a case-controlled retrospective study, we examined the prevalence, patient background, and risk factors for CRKP BSIs.

Results: The overall CRKP BSI incidence was 2.2 (54/2,420,826) per 100,000 patient-days. Acute operation (p = 0.012), being a resident in a long-term-care facility (p = 0.019), transfer to ICU within 30 days (p = 0.014), pulmonary diseases (p = 0.022), renal diseases (p = 0.004), liver diseases (p = 0.008), abdominal infections (p = 0.005), gastric tube (p = 0.011), quinolone use (p = 0.029), carbapenem use (p = 0.001), and antifungal agent use prior to culture within 30 days (p = 0.001) were risk factors for CRKP BSIs. In total, 88.9% (48/54) isolates were detected with KPC carbapenemase, followed by NDM carbapenemase at 7.4% (4/54). YcfM, wabG, and entB were present in all strains. The following four virulence genes had a positivity rate of over 90%: fimH (98.15%), mrkD (96.30%), uge (92.60%), and kpn (92.60%).

Conclusions: Acute operation, being a resident in a long-term-care facility, transfer to ICU within 30 days, pulmonary diseases, renal diseases, liver diseases, abdominal infections, gastric tube, quinolone use, carbapenem use, and antifungal agent use prior to culture within 30 days were risk factors for CRKP BSIs. KPC carbapenemase ranked first in isolates of CRKP BSIs. Virulence genes were widely present.