Clinical characteristics and prognostic risk factors of hospital acquired Klebsiella pneumoniae bloodstream infection

doi:10.3877/cma.j.issn.1674-1358.2020.03.004

Abstract

Abstract:

Objective

To investigate the clinical characteristics and prognostic risk factors of nosocomial Klebsiella pneumonia bloodstream infection (nKP BSI) and provide evidence for clinical treatment of nKP BSI.

Methods

The clinical data including age, gender, inpatient department, complicated diseases, primary infection, invasive treatment, clinical outcome and result of drug sensitivity analysis of hospitalized patients with nKP BSI admitted to the Second Affiliated Hospital of Nanjing Medical University from May 2014 to April 2019 were analyzed, retrospectively. Logistic regression analysis was used to analyze independent risk factors for 28-day prognosis of patients.

Results

The majority of patients with nKP BSI were male (64/90, 71.1%), with a median age of 67.5 (56.75, 82.25) years old. The 90 patients were from 16 clinical departments of the hospital, mostly in ICU (16/90, 17.8%), followed by gastroenterology (12/90, 13.3%) and nephrology (11/90, 12.2%). nKP BSI was often complicated with multiple diseases, and the most common of which was pulmonary infection (52/90, 57.8%). The most common primary infection site was the respiratory tract (33/90, 36.7%), followed by biliary tract (17/90, 18.9%) and catheter-related (12/90, 13.3%). The most common invasive treatment during hospitalization was urinary catheter (38/90, 42.2%), followed by central venous catheter (35/90, 38.9%). Among the 90 isolates, 17 strains were carbapenem resistant Klebsiella pneumoniae (CRKP) and the 28-day mortality rate was 52.9% (9/17). The 28-day mortality rate of nKp BSI was 31.1% (28/90). Multivariate Logistic regression analysis showed that Pitt bacteriaemia score (PBS) ≥ 3 (OR = 5.614, 95%CI: 1.298-24.577, P = 0.021), Charlson comorbidity index (CCI) ≥ 6 (OR = 6.862, 95%CI: 1.480-31.824, P = 0.014) and respiratory failure (OR = 18.534, 95%CI: 1.557-220.628, P = 0.021) were all independent risk factors for 28-day prognosis of patients with nKP BSI.

Conclusions

nKP BSI occurs mainly in elderly male patients. Lower respiratory tract and biliary tract infections were common primary diseases. Urinary catheter and central venous catheterization were important iatrogenic factors for nKP BSI. PBS ≥ 3, CCI ≥ 6 and respiratory failure were important risk factors of prognosis. High attention should be paid to such patients.

Key words: Nosocomial infection, Klebsiella pneumoniae, Bloodstream infection, Clinical features, Prognosis

Ziyan Shen, Shaoqing Lin, Xingran Du, Shuidi Zhao, Ganzhu Feng. Clinical characteristics and prognostic risk factors of hospital acquired Klebsiella pneumoniae bloodstream infection[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(03): 198-205.

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Figures/Tables 6

References 27

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指标		例数（%）
性别		?
?	男	64（71.1）
?	女	26（28.9）
年龄（岁）		?
?	< 40	4（4.4）
?	40～49	12（13.3）
?	50～59	15（16.7）
?	60～69	17（18.9）
?	70～79	18（20.0）
?	80～89	22（24.4）
?	≥ 90	2（2.2）
科室		?
?	ICU	16（17.8）
?	消化内科	12（13.3）
?	肾内科	11（12.2）
?	脑外科	10（11.1）
?	肿瘤内科	10（11.1）
?	普外科	10（11.1）
?	呼吸内科	5（5.6）
?	胸心外科	4（4.4）
?	其他科室	12（13.3）
血流感染原发灶		?
?	呼吸道	33（36.7）
?	胆道	17（18.9）
?	动静脉导管相关	12（13.3）
?	原发性血流感染	9（10.0）
?	腹腔	8（8.9）
?	泌尿系统	4（4.4）
?	其他	7（7.8）

指标		例数（%）
性别		?
?	男	64（71.1）
?	女	26（28.9）
年龄（岁）		?
?	< 40	4（4.4）
?	40～49	12（13.3）
?	50～59	15（16.7）
?	60～69	17（18.9）
?	70～79	18（20.0）
?	80～89	22（24.4）
?	≥ 90	2（2.2）
科室		?
?	ICU	16（17.8）
?	消化内科	12（13.3）
?	肾内科	11（12.2）
?	脑外科	10（11.1）
?	肿瘤内科	10（11.1）
?	普外科	10（11.1）
?	呼吸内科	5（5.6）
?	胸心外科	4（4.4）
?	其他科室	12（13.3）
血流感染原发灶		?
?	呼吸道	33（36.7）
?	胆道	17（18.9）
?	动静脉导管相关	12（13.3）
?	原发性血流感染	9（10.0）
?	腹腔	8（8.9）
?	泌尿系统	4（4.4）
?	其他	7（7.8）

变量		分值
体温（?C）		?
?	35.1～36.0或39.0～39.9	1
?	≤ 35.0或≥ 40.0	2
低血压		2
机械通气		2
心肺复苏		4
意识状态		?
?	清醒	0
?	意识障碍	1
?	昏睡	2
?	昏迷	4

变量		分值
体温（?C）		?
?	35.1～36.0或39.0～39.9	1
?	≤ 35.0或≥ 40.0	2
低血压		2
机械通气		2
心肺复苏		4
意识状态		?
?	清醒	0
?	意识障碍	1
?	昏睡	2
?	昏迷	4

临床特征		数值
男性[例（%）]		64（71.1）
年龄[M（P25，P75）]		67.5（56.75，82.25）
PBS [M（P25，P75）]		2（0.75，4）
CCI [M（P25，P75）]		4（2，6）
合并疾病[例（%）]		?
?	糖尿病	28（31.1）
?	高血压	33（36.7）
?	脑梗死	31（34.4）
?	冠状动脉粥样硬化性心脏病	23（25.6）
?	慢性阻塞性肺病	5（5.6）
?	肾功能不全	21（23.3）
?	慢性肝功能不全	5（5.6）
?	恶性肿瘤	27（30.0）
?	肺部感染	52（57.8）
?	胆道系统感染	19（21.1）
?	肝脓肿	5（5.6）
?	泌尿系统感染	2（2.2）
?	感染性休克	13（14.4）
?	低蛋白血症	30（33.3）
?	呼吸衰竭	12（13.3）
侵入性诊疗操作[例（%）]		?
?	中心静脉置管	35（38.9）
?	外周静脉置管	32（35.6）
?	有创机械辅助通气	24（26.7）
?	胃管	16（17.8）
?	尿管	38（42.2）
?	其他导管（引流管）	28（31.1）
?	穿刺	9（10.0）
?	手术	32（35.6）
?	血液透析	13（14.4）
临床结局[例（%）]		?
?	入住ICU史	20（22.2）
?	28 d病死	28（31.1）
住院天数[M（P25，P75）]		19（13，32.25）
药敏试验[例（%）]		?
?	MDR	40（44.4）
?	CRKP	17（18.9）

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