Guojie Zhang1, Meng Zhang2, Fangyan Sun1, Jiong Zhou1, Yao Wang3, Dawei Zhu4, Zheng Chen1, Qian Chen1, Qing Chang1, Haimin Liu2, Wenzhao Chai5, Hui Pan6. 1. Department of Medical Affairs, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. 2. Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. 3. Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. 4. China Center for Health Development Studies, Peking University, Beijing 100191, China. 5. Department of Medical Affairs, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: chaiwenzhao@126.com. 6. Department of Medical Affairs, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. Electronic address: panhui20111111@163.com.
Abstract
BACKGROUND: This study compared the epidemiology of carbapenem-resistant (CRKP) and carbapenem-sensitive (CSKP) K. pneumoniae bloodstream infections (BSIs), and assessed risk factors for 28-day mortality of patients with K. pneumoniae BSIs. METHODS: A retrospective cohort study was conducted in a 2000-bed tertiary teaching hospital of Beijing between Jan 1st 2013 to Dec 31st, 2019. All patients with K. pneumoniae BSI were identified through the Hospital Information System. The endpoints included incidence rate, mortality and risk factors for mortality of patients with K. pneumoniae BSIs. RESULTS: 496 patients with K. pneumoniae BSIs were included in the analysis, with 108 CRKP BSIs. The incidence rate of K. pneumoniae BSI was 10.6 (CI: 9.7, 11.6) per 100 000 patient-days, with the rate for CRKP BSI was 2.3 (95% CI: 1.9, 2.8). The 28-day mortality was 38.0% for CRKP BSI and 8.8% for CSKP BSI, respectively. Logistic analysis showed, higher Charlson Comorbidity Index score (OR = 1.26, 95%CI 1.12-1.43, p < 0.001), respiratory failure (OR = 2.73, 95%CI1.28-5.84, p = 0.010), renal failure (OR = 4.13, 95%CI1.93-8.83, p < 0.001), septic shock (OR = 8.77, 95%CI3.60-21.32, p < 0.001), mechanical ventilation (OR = 4.41, 95%CI1.59-12.25, p = 0.004) and CRKP infection (OR = 3.04, 95%CI1.28-7.22, p = 0.012) were independently associated with 28-day mortality. CONCLUSIONS: Considerable incidence rate and remarkable mortality of patients with K. pneumoniae (especially CRKP) BSI was declared in the study. Patient conditions before (higher CCI) and after presentation (respiratory failure, renal failure, septic shock), and healthcare factors (mechanical ventilation and CRKP infection) were independently associated with 28-day mortality. Understanding these risks helps better establishment of infection control strategies.
BACKGROUND: This study compared the epidemiology of carbapenem-resistant (CRKP) and carbapenem-sensitive (CSKP) K. pneumoniae bloodstream infections (BSIs), and assessed risk factors for 28-day mortality of patients with K. pneumoniae BSIs. METHODS: A retrospective cohort study was conducted in a 2000-bed tertiary teaching hospital of Beijing between Jan 1st 2013 to Dec 31st, 2019. All patients with K. pneumoniae BSI were identified through the Hospital Information System. The endpoints included incidence rate, mortality and risk factors for mortality of patients with K. pneumoniae BSIs. RESULTS: 496 patients with K. pneumoniae BSIs were included in the analysis, with 108 CRKP BSIs. The incidence rate of K. pneumoniae BSI was 10.6 (CI: 9.7, 11.6) per 100 000 patient-days, with the rate for CRKP BSI was 2.3 (95% CI: 1.9, 2.8). The 28-day mortality was 38.0% for CRKP BSI and 8.8% for CSKP BSI, respectively. Logistic analysis showed, higher Charlson Comorbidity Index score (OR = 1.26, 95%CI 1.12-1.43, p < 0.001), respiratory failure (OR = 2.73, 95%CI1.28-5.84, p = 0.010), renal failure (OR = 4.13, 95%CI1.93-8.83, p < 0.001), septic shock (OR = 8.77, 95%CI3.60-21.32, p < 0.001), mechanical ventilation (OR = 4.41, 95%CI1.59-12.25, p = 0.004) and CRKP infection (OR = 3.04, 95%CI1.28-7.22, p = 0.012) were independently associated with 28-day mortality. CONCLUSIONS: Considerable incidence rate and remarkable mortality of patients with K. pneumoniae (especially CRKP) BSI was declared in the study. Patient conditions before (higher CCI) and after presentation (respiratory failure, renal failure, septic shock), and healthcare factors (mechanical ventilation and CRKP infection) were independently associated with 28-day mortality. Understanding these risks helps better establishment of infection control strategies.