Carbapenem-susceptible versus carbapenem-resistant Klebsiella pneumoniae bloodstream infection: Clinical manifestations and risk factors

Objective To study the clinical characteristics of K.pneumoniae bloodstream infection, and explore the risk factors for bloodstream infection caused by carbapenem-resistant K.pneumoniae (CRKP). Methods Clinical data about 190 cases with K.pneumoniae bloodstream infection in Chinese PLA General Hospital from June 2011 to August 2016 were retrospectively analyzed. The patients were divided into two groups according to resistance to carbapenem, patients with CRKP bloodstream infection and those with carbapenem-susceptive K.pneumoniae (CSKP) bloodstream infection. The independent risk factors of CRKP bloodstream infection were identified by logistic regression analysis. Results There were 190 non-duplicated K.pneumoniae blood isolates identified in our research, with the overall proportion of carbapenem-resistant strains reaching 31.6% over the past five years.In logistic regression analysis, being exposed to antibiotics (OR=5.06, 95% CI : 2.15-11.93, P=0.000), complicated with respiratory diseases (OR=3.99, 95% CI : 1.49-10.7, P=0.006) and receiving indwell invasive devices (OR=26.00, 95% CI : 2.88-234.98, P=0.004)were identified as independent risk factors for CRKP bloodstream infection. Conclusion Carbapenem-resistant K.pneumoniae is an emerging multi-drug resistant nosocomial pathogen. Indwelling invasive devices in hospital and being exposed to antibiotics, especially carbapenem and beta-lactam/lactamase inhibitors, are associated with the produce of carbapenem-resistant strains.