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. 2021 Dec 20:14:5555-5562.
doi: 10.2147/IDR.S343489. eCollection 2021.

Clinical Characteristics and Risk Factors for Critically Ill Patients with Carbapenem-Resistant Klebsiella pneumonia e (CrKP): A Cohort Study from Developing Country

Ying-Yi Luan #  1 , Yan-Hong Chen #  2 , Xue Li  3 , Zhi-Peng Zhou  2 , Jia-Jia Huang  2   4 , Zhen-Jia Yang  2   4 , Jing-Jing Zhang  2   5 , Ming Wu  2   4   6
Affiliations

Clinical Characteristics and Risk Factors for Critically Ill Patients with Carbapenem-Resistant Klebsiella pneumonia e (CrKP): A Cohort Study from Developing Country

Ying-Yi Luan et al. Infect Drug Resist. .

Abstract

Background: Increasing evidence indicates carbapenem-resistant Klebsiella pneumoniae (CrKP) is increasingly prevalent in intensive care unit (ICU), but its clinical characteristics and risk factors remain unknown.

Aim: The aim of the present study was to evaluate clinical characteristics, risk factors in critically ill patients with CrKP infection.

Methods: A retrospective study was included in patients from January 2013 to October 2019. Clinical data were collected from CrKP patients on the day of specimen collection admitted to ICU. Multivariable logistic regression was used for risk factors. Receiver operating curve (ROC) and the area under the curve (AUC) with DeLong method of MedCalc software were used. Two-way repeated-measures ANOVA analysis was used to analyze the characteristics of independent risk factors over time.

Findings: A total of 147 adult patients with CrKP were screened, among them, 89 (median age 64.0 years, 66 (74.15%) males) patients with CrKP were finally included, of which 38 patients (42.7%) were non-survival group. Multivariate logistic regression analysis indicated that lactic acid (OR3.04 95% CI 1.38-6.68, P = 0.006), APACHE II score (OR 1.20, 95% CI 1.09-1.33, P < 0.001), tigecycline combined with fosfomycin treatment (OR0.15, 95% CI 0.04-0.65, P = 0.011) are independent risk factors for 28-day mortality in patients with CRKP infection (P<0.05). Combined lactic acid with APACHE II score could predict 28-day mortality, of which AUC value was 0.916 (95% CI, 0.847-0.985), with sensitivity 0.76 and specificity 0.98. ANOVA analysis showed that APACHE II score and lactic acid between the two groups at three-time points were statistically significant, which interactive with time and showed an upward and downward trend with time (P < 0.05).

Conclusion: Therapeutic strategy based on improving lactic acid and APACHE II would contribute to the outcome in patients with CrKP infection. Tigecycline combined with fosfomycin could reduce the 28-day mortality in patients with CrKP infection in developing country.

Keywords: APACHE II score; carbapenem resistant Klebsiella pneumoniae; fosfomycin; lactic acid; mortality; tigecycline.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

Figures

Figure 1
Figure 1
Diagram of patient eligibility and flow.
Figure 2
Figure 2
Combined model, lactate and APACHE II score for predicting 28-day in CRKP patients.
See this image and copyright information in PMC

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