Risk factors and mortality associatied with Carbapenem-resistant Klebsiella pneumoniae bloodstream infections; a tertiary hospital experience from Turkey

Öz

OBJECTIVES: Klebsiella pneumoniae is one of the most important multidrug-resistant microorganisms. Among the infections caused by Carbapenem-resistant Klebsiella pneumoniae (CRKP), bloodstream infections (BSI) have the highest mortality rate. The aim of this study was to evaluate the risk factors associated with healthcare-associated CRKP BSI, mortality rates of K. pneumoniae BSI and the factors affecting mortality in patients followed in the intensive care unit (ICU). METHODS: This study was designed as a retrospective case-control study. Patients were divided into two groups according to their carbapenem resistance; Group 1: Patients with CRKP growth in blood cultures and Group 2: Patients with carbapenem sensitive K. Pneumoniae (CSKP) growth in blood cultures. Clinical and demographic characteristics, 14-day and all-cause mortality rates and factors affecting mortality were compared between the groups. RESULTS: Rates of having higher body mass index, having DM, ICU admission due to COVID-19, prior use of carbapenems, a longer ICU stay before the infection were significantly higher in the CRKP group compared to CSKP group. In multivariate regression analysis having DM, ICU admission due to COVID-19, prior use of carbapenems, CRRT in the ICU were risk factors for CRKP BSI. When ICU deaths due to all causes are evaluated, only infection with CRKP was found to be a risk factor for ICU mortality. CONCLUSIONS: Detection of CRKP BSI risk factors is important. In our study, the presence of CRKP BSI was found to be an independent risk factor for mortality in ICUs.

Anahtar Kelimeler

• bloodstream infections
• Carbapenem-resistant Klebsiella pneumoniae
• intensive care unit

Karbapenem dirençli Klebsiella Pneumoniae kan dolaşım yolu enfeksiyonlarında risk faktörü ve mortalite; Türkiye’den bir üçüncü basamak hastane deneyimi

Öz

AMAÇLAR: Klebsiella pneumoniae, en önemli çoklu ilaca dirençli mikroorganizmalardan biridir. Karbapenem dirençli Klebsiella pneumoniae'nin (CRKP) neden olduğu enfeksiyonlar arasında, kan dolaşım yolu enfeksiyonları (KDYE) en yüksek ölüm oranına sahiptir. Bu çalışmanın amacı, sağlık bakımıyla ilişkili CRKP KDYE ile ilişkili risk faktörlerini, K. pneumoniae KDYE ölüm oranlarını ve yoğun bakım ünitesinde takip edilen hastalarda mortaliteyi etkileyen faktörleri değerlendirmektir. YÖNTEMLER: Bu çalışma retrospektif bir vaka-kontrol çalışması olarak tasarlanmıştır. Hastalar karbapenem dirençlerine göre iki gruba ayrıldı; Grup 1: Kan kültürlerinde CRKP üremesi olan hastalar ve Grup 2: Kan kültürlerinde karbapenem duyarlı K. Pneumoniae (CSKP) üremesi olan hastalar. Gruplar arasında klinik ve demografik özellikler, 14 günlük ve tüm nedenlere bağlı mortalite oranları ve mortaliteyi etkileyen faktörler karşılaştırıldı. BULGULAR: CRKP grubunda daha yüksek vücut kitle indeksi, DM, COVID-19 nedeniyle yoğun bakıma yatış, daha önce karbapenem kullanımı, enfeksiyondan önce daha uzun süre yoğun bakımda kalma oranları CSKP grubuna kıyasla anlamlı derecede daha yüksekti. Çok değişkenli regresyon analizinde DM, COVID-19 nedeniyle yoğun bakıma yatış, daha önce karbapenem kullanımı, yoğun bakımda devamlı renal replasman tedavisi CRKP KDYE için risk faktörleriydi. Tüm nedenlere bağlı yoğun bakım ölümleri değerlendirildiğinde, yalnızca CRKP enfeksiyonunun yoğun bakım mortalitesi için bir risk faktörü olduğu bulundu. SONUÇLAR: CRKP KDYE risk faktörlerinin tespiti önemlidir. Çalışmamızda CRKP KDYE varlığının yoğun bakımlarda mortalite için bağımsız bir risk faktörü olduğu bulundu.

Anahtar Kelimeler

• bakteriyemi
• karbapenem dirençli klebsiella pneumoniae
• yoğun bakım ünitesi

Kaynakça

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