Clinical characteristics and outcomes of 114 bloodstream infections caused by Klebsiella pneumoniae in adult patients

Objective To retrospectively analyze the clinical features and risk factors for death of patients with bloodstream infection (BSI) caused by Klebsiella pneumonia in adults for improving early prevention and effective treatment of K. pneumoniae BSI. Methods The medical records were collected from 114 adult patients with K. pneumoniae BSI and 335 patients with non-BSI infection caused by K. pneumoniae who were treated in Fujian Provincial Hospital from June 1, 2017 to May 31, 2019. The clinical characteristics, antimicrobial treatment, and outcomes of K. pneumoniae BSI were analyzed. SPSS 26.0 software was used to perform multivariate binary logistic regression analysis to identify the risk factors for the occurence and mortality of K. pneumoniae BSI. Results The K. pneumoniae BSI mainly occurred in intensive care unit (28.95%, 33/114), departments of hepatobiliary surgery (14.91%, 17/114), and gastroenterology (14.04%, 16/114). Malignant tumor, liver abscess, and deep venous catheterization were independent risk factors for the occurrence of K. pneumoniae BSI. K. pneumoniae BSI was associated with a significantly higher 28-day mortality rate compared with K. pneumoniae non-BSI infection (25.44% vs 14.93%, P = 0.011). The patients with K. pneumoniae BSI were also more likely to develop septic shock and complicated with multiple organ dysfunction syndrome (MODS) (P < 0.001). The prevalence of carbapenem-resistant K. pneumoniae (CRKP) was 20.18% (23/114) in adult patients with K. pneumoniae BSI. CRKP BSI was associated with significantly higher mortality rate than carbapenem-susceptible K. pneumoniae (CSKP) BSI (69.57% vs 14.29%). Presence of ≥ 2 sites of infection, CRKP infection, and APACHE II score ≥ 10 were independent risk factors for death in patients with K. pneumoniae BSI. Conclusions Patients with K. pneumoniae BSI have a high mortality rate and are prone to MODS and septic shock. Clinicians should be aware of the risk of K. pneumoniae BSI in patients with malignant tumor, liver abscess, and deep venous catheterization. Multiple sites of infection, CRKP infection, and critical condition will increase the risk of death in patients with K. pneumoniae BSI.