Klebsiella pneumoniae Infections in Intensive Care Unit and Risk Factors for Carbapenem Resistance

Objective: Klebsiella pneumoniae infections have been a problem in intensive care units (ICU) in recent years due to multi-drug resistance. In this study, it was aimed to analyze K. pneumoniae infections in ICU, determine distribution of carbapenem resistance rates and risk factors. Methods: Nosocomial infections (NI) with K. pneumoniae between January 2017-January 2020 were evaluated retrospectively. In cases with recurrent K. pneumoniae infection, only the first episode was included. Results: K. pneumoniae infections were developed in a total of 78 patients. Bloodstream infections (BSI) were the most common (51.3%), followed by pneumonia (41%) and urinary tract infections (7.7%). Among BSI cases, 52.5% were associated with central venous catheter (CVC) and 81.2% of pneumonia cases were ventilator-associated pneumonia (VIP). It was observed that while the proportion of BSI was gradually decreasing in years, pneumonia rates have increased. Among BSI, it was observed that the rate of CVC-related BSI was increased from 33.3% in 2017 to 62.5% in 2019. Carbapenem resistance was 52.6% and colistin resistance was 17.9% in K. pneumoniae isolates and both increased over 3 years. When carbapenem-resistant K. pneumoniae infections were compared with carbapenem-sensitive K. pneumoniae infections, the independent risk factors associated with carbapenem resistance were found to be carbapenem use (p=0.008, OR: 8.45, 95% CI: 1.76-40.64), prior NI developing with different microorganism (p=0.005, OR: 8.70, 95% CI: 1.91-39.65) and total parenteral nutrition (TPN) use (p=0.04, OR: 4.2, 95% CI: 1.06-16.67). Conclusions: Carbapenem-resistant K. pneumoniae infections are gradually increasing in ICUs, and colistin resistance has started to be observed recently. Our study showed that carbapenems are independent risk factors in carbapenem resistance and suggested that carbapenem use should be restricted in our unit. It is important for each center to reveal its own data of frequency and resistance, in order to decrease infection rates with the infection control measures and determine the antibiotic using policies.