Risk factors of bloodstream infection of carbapenem-resistant Klebsiella pneumoniae

  Objective  To identify the multi-risk factors od bloodstream infection of carbapenem-resistant Klebsiella pneumoniae (CRKP), and provide evidence for the clinical diagnosis, treatment and prevention of infection disease.

  Methods   The retrospective analysis was carried out by using the clinical data of the bloodstream CRKP infection cases with completed medical records diagnosed in the affiliated hospital of North China University of Science and Technology from January 2013 to December 2020, the patients infected with carbapenem-sensitive Klebsiella pneumoniae (CSKP) during the same period were included as control group . Software SPSS 23.0 was used for univariate and multivariate analyses to identify the risk factors for bloodstream infection of CRKP.

  Results  The case fatality rate in bloodstream CRKP infection group was significantly higher than that in bloodstream CSKP infection group (χ²=31.396, P<0.001). The 56 patients with bloodstream CRKP infection were mainly distributed in intensive care unit (ICU) (80.36%). Univariate analysis indicated that the differences in prevalence of hypoproteinemia, uses of β-lactams (except carbapenems), carbapenem antibiotics, quinolone antibiotics and hormone before infection and the uses of indwelling invasive instruments, indwelling central catheter, indwelling stomach tube, indwelling catheter, ventilator assistance of mechanical ventilation and ICU stay before infection were significant between the two groups, (P<0.05). The binary logistic regression analysis showed that the use of carbapenem antibiotics (OR=26.310, P<0.001) and the use of indwelling central venous catheter (OR=9.534, P=0.035) before infection were the independent risk factors of bloodstream CRKP infection.

  Conclusion  The cases fatality of bloodstream CRKP infection was high. Using carbapenem antibiotics before infection and using indwelling central venous catheters often indicate poor prognosis. It is suggested to have a rational use of antibiotics and improve the prevention and control of nosocomial infection.