Factors affecting mortality in patients with healthcare-associated bloodstream infection due to Klebsiella pneumoniae.

INTRODUCTION

Klebsiella pneumoniae is a common causative agent of hospital-acquired (HA) bloodstream infections (BSI) in intensive care units (ICU). This study aimed to investigate mortality rates and the factors affecting mortality in BSI due to K. pneumoniae acquired in the ICU.

METHODOLOGY: This retrospective study included adult patients hospitalized in the ICU between January 2021 and December 2022 who developed HA BSI due to K. pneumoniae. The association between clinical characteristics, invasive and medical treatment practices before bacteremia, and 15-day and 30-day mortality was investigated.

RESULTS

A total of 232 patients (median age 68.0 years) were included. All-cause mortality rates on days 15 and 30 were 56.0% and 72.8%, respectively. The proportion of patients infected with carbapenem-resistant K. pneumoniae was 77.6%. Logistic regression analysis revealed significant associations between systemic corticosteroid use (OR: 2.38; p = 0.014), high qPitt score (OR: 1.32; p = 0.046), and presence of immunosuppression (OR: 2.70; p = 0.020); and 15-day mortality. Significant associations were found between systemic corticosteroid use (OR: 3.69; p = 0.002), high qPitt score (OR: 1.44; p = 0.043) and presence of immunosuppression (OR: 6.61; p = 0.004); and 30-day mortality.

CONCLUSIONS

Corticosteroid treatment before the development of bacteremia in ICU patients may contribute to mortality in BSI due to K. pneumoniae. Therefore, corticosteroids should be used with caution despite their benefit in the treatment of acute respiratory distress syndrome. High qPitt scores and the presence of immunosuppression may be used as predictors of mortality in HA BSI due to K. pneumoniae.