Predictors of 30-day mortality in critically ill patients with bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: a five-year retrospective study.

BACKGROUND: Infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) are increasingly contributing to mortality in ICU patients. The study aimed to evaluate outcomes, identify mortality predictors, and assess antibiotic strategies for treating KPC-Kp bloodstream infections (BSIs) in critically ill ICU patients. MATERIALS AND METHODS: This retrospective study at Chang Gung Memorial Hospital, Taiwan, from January 2017 to December 2021, analyzed 168 adult ICU patients with KPC-Kp BSIs. All patients experienced respiratory failure and were on mechanical ventilation. RESULTS: The 30-day mortality rate was 61.9%. Patients who died had higher Pitt bacteremia (7.0 ± 2.6 vs. 4.2 ± 2.9, P < 0.001) and SOFA scores (12.0 ± 4.1 vs. 6.2 ± 3.8, P < 0.001), greater need for renal replacement therapy (27.9% vs. 9.4%, P < 0.002), and higher intra-abdominal infection prevalence (9.6% vs. 0%, P < 0.001). Lower platelet counts (93.7 ± 84.7 vs. 171.1 ± 120.2, P < 0.001) and higher CRP levels (131.3 ± 92.3 vs. 88.7 ± 81.0, P < 0.003) were observed in deceased patients. Multivariate analysis identified CRP levels and SOFA scores as independent mortality predictors, while ceftazidime-avibactam treatment and appropriate antibiotic therapy within 48 h post-BSI onset correlated with better outcomes. CONCLUSIONS: Early appropriate antibiotic treatments and ceftazidime-avibactam use are crucial for reducing mortality in critically ill ICU patients. CLINICAL TRIAL NUMBER: Not applicable.