Risk factors for multidrug-resistant and carbapenem-resistant Klebsiella pneumoniae bloodstream infections in Shanghai: A five-year retrospective cohort study

Abstract

Background Multidrug-resistant Klebsiella pneumoniae (MDRKP) and carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSIs) account for significant mortality and healthcare costs. Objectives To investigate risk factors for MDRKP and CRKP BSIs Methods A retrospective analysis of inpatients with Klebsiella pneumoniae bloodstream infections (KP BSIs) was conducted in a tertiary care hospital in Shanghai from 01/01/2018–31/12/2022. Temporal distribution of mortality and department distribution of KP BSIs were assessed. A generalized linear model was used to determine risk factors for MDRKP and CRKP BSIs. Results A total of 379 inpatients with KP BSIs were included. The proportion of death for KP BSIs, MDRKP BSIs and CRKP BSIs gradually decreased since 2020. Majority of both MDRKP and CRKP BSIs patients were from Intensive Care Unit (ICU), burn unit, hematology and pancreatic surgery. Genitourinary disorders, invasive ventilator, history of antibiotic use, and carbapenem use were independently associated with MDRKP BSIs. Respiratory disease, gastric tubes, carbapenem use and its quantity were independently associated with CRKP BSIs. Conclusions ICU, burn unit, hematology and pancreatic surgery are common departments for MDRKP and CRKP BSIs. Genitourinary disorders, respiratory disorders, invasive ventilator, gastric tubes and antibiotic use (carbapenems in particular) within 90 days prior to onset of BSIs are independently associated with MDRKP and CRKP BSIs.