Acta tropica · 2025
Does carbapenem resistance influence clinical outcomes in ICU patients with Klebsiella pneumoniae bacteraemia? A comparative analysis of Carbapenem-resistant and susceptible isolates.
СтатьяНаблюдательное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Bhat Divya, Rajan Asha K, Aditya Vankadari, Eshwara Vandana Kalwaje, Varma Muralidhar, Umakanth Shashikiran, Thunga Girish, Shanbhag Vishal
Аннотация
BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a critical pathogen associated with high mortality in bloodstream infections, particularly in regions with high antimicrobial resistance. Aim of this study was to identify antimicrobial resistance patterns, clinical outcomes, and independent risk factors for mortality among patients with K. pneumoniae bacteraemia (KPB), comparing CRKP and carbapenem sensitive K. pneumoniae (CSKP) infections.
METHODS: A retrospective observational study was conducted among adult ICU patients diagnosed with KPB between January to December 2023. Demographics, comorbidities, laboratory markers, treatment details, and clinical outcomes were matched between CRKP and CSKP groups. Univariate and multivariate logistic regression were used to identify independent predictors of mortality. Kaplan-Meier analysis was used to assess survival differences. All the analyses were performed using SPSS vs 20.0 software.
RESULTS: Among 116 patients, 55.2 % had CRKP bacteraemia. CRKP patients had old age (>65 years) and had higher rates of comorbidities including chronic liver (26.5 %) and kidney disease (15.6 %). Overall mortality rate was higher in CRKP patients (57.8 %). Seven factors were independently associated with mortality: old age [OR:1.402(1.097-2.005)], chronic liver disease [OR:1.21(1.039-3.12)], chronic kidney disease [OR:2.30(1.277-6.098)]), prior carbapenem resistance [OR:1.369(1.037-3.66)], elevated CRP [OR:2.002(1.097-3.06)], vasopressor use within 48 h [OR:1.332(1.007-2.148)] and early septic shock [OR:1.99(1.071-5.649)]. Kaplan-Meier survival curves showed higher early mortality in CRKP patients, suggesting that they died even before a conventional culture report was available.
CONCLUSION: Patients with CRKP bacteraemia showed significantly higher clinical severity and early mortality compared to those with CSKP infections. Rapid diagnostics, early appropriate empirical therapy in high-risk patients of CRKP and integrated stewardship strategies are critical for better outcomes. These findings offer actionable insights for risk stratification, diagnostic stewardship and timely intervention in high-burden settings.
METHODS: A retrospective observational study was conducted among adult ICU patients diagnosed with KPB between January to December 2023. Demographics, comorbidities, laboratory markers, treatment details, and clinical outcomes were matched between CRKP and CSKP groups. Univariate and multivariate logistic regression were used to identify independent predictors of mortality. Kaplan-Meier analysis was used to assess survival differences. All the analyses were performed using SPSS vs 20.0 software.
RESULTS: Among 116 patients, 55.2 % had CRKP bacteraemia. CRKP patients had old age (>65 years) and had higher rates of comorbidities including chronic liver (26.5 %) and kidney disease (15.6 %). Overall mortality rate was higher in CRKP patients (57.8 %). Seven factors were independently associated with mortality: old age [OR:1.402(1.097-2.005)], chronic liver disease [OR:1.21(1.039-3.12)], chronic kidney disease [OR:2.30(1.277-6.098)]), prior carbapenem resistance [OR:1.369(1.037-3.66)], elevated CRP [OR:2.002(1.097-3.06)], vasopressor use within 48 h [OR:1.332(1.007-2.148)] and early septic shock [OR:1.99(1.071-5.649)]. Kaplan-Meier survival curves showed higher early mortality in CRKP patients, suggesting that they died even before a conventional culture report was available.
CONCLUSION: Patients with CRKP bacteraemia showed significantly higher clinical severity and early mortality compared to those with CSKP infections. Rapid diagnostics, early appropriate empirical therapy in high-risk patients of CRKP and integrated stewardship strategies are critical for better outcomes. These findings offer actionable insights for risk stratification, diagnostic stewardship and timely intervention in high-burden settings.