Risk factors for bloodstream infections and mortality in carbapenem-resistant versus susceptible Klebsiella pneumoniae: a six-year retrospective cohort study.

BACKGROUND

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical global health threat, with rising resistance rates and high mortality in bloodstream infections (BSIs). In China, the prevalence of CRKP has increased, particularly in Henan Province, where resistance rates are among the highest. However, regional epidemiological data are limited. In the present study, CRKP-BSI and carbapenem-susceptible Klebsiella pneumoniae BSIs (CSKP-BSI) were investigated, resistance patterns were analyzed, and risk factors for CRKP-BSI and KP-BSI were evaluated. The primary objective was to identify the risk factors for CRKP-BSI, while the secondary objective was to determine the risk factors for in-hospital mortality among patients with KP-BSI.

METHODS

The present study included patients with KP-BSI who were hospitalized in a tertiary hospital in Henan with 1,800 beds from January 1, 2019, to December 31, 2024. A retrospective analysis of patients with KP-BSI was conducted, and clinical data on patient demographics, comorbidities, and discharge outcomes were collected. Univariate and multivariate regression analyses were performed to identify independent risk factors for CRKP-BSI and in-hospital mortality rates associated with KP-BSI.

RESULTS

A total of 414 patients with KP-BSI were included in the study, comprising 90 patients with CRKP-BSI and 324 patients with CSKP-BSI. The independent risk factors for CRKP-BSI included a history of intensive care unit (ICU) admission (OR = 10.49, p = 0.0002), hospital-acquired infection (OR = 9.34, P < 0.0001), hypertension (OR = 2.85, P = 0.0106), and surgery within 30 days prior to infection (OR = 5.88, P = 0.0002). The overall in-hospital mortality rate was 11.8%. The mortality rates of patients with CRKP-BSI and CSKP-BSI were 21.1% and 9.3%, respectively. The independent risk factors for in-hospital mortality due to KP-BSI were a history of ICU admission (OR = 6.03, P < 0.0001) and the presence of lower respiratory tract infections (OR = 2.44, P = 0.0103).

CONCLUSIONS

In this comprehensive study, we identified several critical risk factors for CRKP-BSI, including ICU admission, healthcare-associated infection, hypertension, and recent surgical intervention. Moreover, ICU admission and lower respiratory tract infection were identified as independent predictors of in-hospital mortality in patients with KP-BSI.

CLINICAL TRIAL NUMBER: Not applicable.