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Comparative Study
. 2025 Jun 17:15:1600746.
doi: 10.3389/fcimb.2025.1600746. eCollection 2025.

A comparative analysis of clinical outcomes in hematological patients afflicted with bacteremia attributable to carbapenem-resistant Klebsiella pneumoniae versus Escherichia coli

Jiali Wang #  1   2 , Jia Liu #  3 , Qingsong Lin  1   2 , Fengkui Zhang  1   2 , Yizhou Zheng  1   2 , Zhijian Xiao  1   2 , Jianxiang Wang  1   2 , Aiming Pang  1   2 , Yi He  1   2 , Erlie Jiang  1   2 , Sizhou Feng  1   2 , Mingzhe Han  1   2 , Weihua Zhai  1   2
Affiliations
Comparative Study

A comparative analysis of clinical outcomes in hematological patients afflicted with bacteremia attributable to carbapenem-resistant Klebsiella pneumoniae versus Escherichia coli

Jiali Wang et al. Front Cell Infect Microbiol. .

Abstract

Introduction: Carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSI) represent a frequent and grave complication among hematological patients, whose prevailing culprits are Carbapenem-Resistant Klebsiella pneumoniae (CRKP) and Escherichia coli bacteremia (EC). Nevertheless, there is a paucity of studies that have undertaken a comparative analysis of clinical outcomes in patients afflicted with CRKP and EC.

Methods: This study was conducted with the aim of identifying the microbiological and clinical characteristics of hematological patients suffering from bacteremia caused by CRKP and CREC.

Results: The cohort included 90 patients with equal proportions of CRKP BSI and CREC BSI from 2017 to 2022. Among the tested CRE strains (n = 45) for carbapenemase (CP) genes, the KPC gene was most commonly found in CP-CRKP isolates (12/21), while the NDM gene predominated among CP-CREC strains (18/24). A comparison of drug susceptibility showed that CREC was significantly more susceptible to tigecycline than CRKP (97.73% vs. 64.86%, P = 0.018). Patients treated with tigecycline-based therapy had a higher survival rate in the CREC group (18/24,75%) compared to the CRKP group (8/14,57.1%). The CRKP group had a significantly lower rate of prior cephalosporin use within 30 days compared to the CREC group (27% vs. 49%, P = 0.03) and a higher incidence of multi-site infections before BSI (44% vs. 8.9%, P<0.001). Multivariate analysis showed that BSI caused by CRKP was an independent risk factor for survival (P = 0.029), while CAZ-AVI-based therapy emerged as an independent factor improving patient prognosis (P =0.013).

Conclusions: Our results found that bacteremia instigated by CRKP was associated with a less favorable prognosis when compared to cases induced by CREC. Moreover, treatment regimens incorporating CAZ-AVI have the potential to enhance the prognosis of patients grappling with CRE BSI.

Keywords: bacteremia; carbapenem resistant Escherichia coli; carbapenem-resistant Klebsiella pneumoniae; clinical outcomes; hematological patients.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Participant flow diagram.
Figure 2
Figure 2
Thirty mortality rates by time from blood collection to appropriate therapy, ceftazidime/Avibactam-based therapy, and other active antibiotics. Other active antibiotics refer to antimicrobial agents that were active in vitro against the isolates, except for ceftazidime-avibactam.
Figure 3
Figure 3
Kaplan-Meier curve of the 30-day survival probability of all patients with CRE BSI (A) patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) or carbapenem-resistant Escherichia coli (CREC) bacteria. (B) patients with ceftazidime-avibactam (CAZ-AVI) based therapy or non-ceftazidime-avibactam-based (Non-CAZ-AVI) therapy.
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