Predictors of Mortality in Critically Ill Patients with Blood-stream Infections Caused by Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae

Abstract

Abstract Background Infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp), particularly blood-stream infections (BSIs), are increasingly emerging as contributors to mortality in intensive care unit (ICU) patients. The challenge in treating KPC-Kp induced BSIs lies in the difficulty of providing early active antibiotic therapy and limited number of effective antibiotics available. The aim of this study was to identify predictive factors for mortality in critically ill ICU patients with KPC-Kp induced BSIs. Materials and Methods This retrospective study included the data of adult patients who had KPC-Kp induced BSIs and were admitted to the ICU of Chang Gung Memorial Hospital, Taoyuan, Taiwan, during the period from January 2017 to December 2021. All patients experienced respiratory failure and were on mechanical ventilation. We analyzed the outcomes in the patients with KPC-Kp induced BSIs. Results We included 168 patients with KPC-Kp BSIs during the study period. The 30-day mortality rate was 61.9%. Compared with the patients who survived, those who died had a higher Pitt bacteremia score (7.0 ± 2.6 vs 4.2 ± 2.9, P < 0.001), higher sequential organ failure assessment (SOFA) score (12.0 ± 4.1 vs6.2 ± 3.8, p < 0.001), a greater need for continuous renal replacement therapy (27.9% vs 9.4%, P < 0.002), and a higher prevalence of intra-abdominal infections (9.6% vs 0%, P < 0.001). In addition, patients who died within 30 days had lower platelets counts (93.7 ± 84.7 vs 171.1 ± 120.2, P < 0.001) and higher C-reactive protein (CRP) levels (131.3 ± 92.3 vs 88.7 ± 81.0, P < 0.003). Our multivariate analysis revealed that CRP levels and SOFA scores were independently associated with mortality, whereas treatment with a Ceftazidime-Avibactam based regimen and appropriate antibiotic treatment within 48 hours after BSIs onset were independently associated with favorable outcome. Conclusions Appropriate antibiotic treatments within 48 hours after BSIs onset and Ceftazidime-Avibactam treatment are crucial for reducing mortality among critically ill ICU patients.