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.