Clinical Characteristics, Risk Factors, and Outcomes of Patients with Polymicrobial Klebsiella pneumoniae Bloodstream Infections

• Published in: BioMed research international 2021, Vol.2021 (1), p.6619911
• Main Authors: Song, Feizhen, Zhang, Kai, Huang, Jianjiang, Qian, Zhenhua, Zhou, Hongwei, Cai, Jiachang, Zheng, Cheng, Zhou, Feifei, Cui, Wei, Zhang, Gensheng
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Antibiotics; Bacteremia - microbiology; Bacteria; Carbapenems; Carbapenems - pharmacology; Comorbidity; Confidence intervals; Diagnosis; Drug dosages; Electronic health records; Electronic medical records; Ertapenem - pharmacology; Female; Gram-negative bacteria; Gram-positive bacteria; Hospitalization; Hospitals; Humans; Imipenem - pharmacology; Infections; Intensive Care Units; Intubation; Klebsiella; Klebsiella infections; Klebsiella Infections - blood; Klebsiella pneumoniae; Klebsiella pneumoniae - metabolism; Laboratories; Male; Meropenem - pharmacology; Microbial Sensitivity Tests; Middle Aged; Mortality; Multivariate Analysis; Odds Ratio; Pathogens; Patient outcomes; Patients; Retrospective Studies; Risk analysis; Risk Factors; Sepsis; Statistical analysis; Survival analysis; Time Factors; Treatment Outcome
• ISSN: 2314-6133; 2314-6141; 2314-6141
• DOI: 10.1155/2021/6619911

Background. Polymicrobial Klebsiella pneumoniae bloodstream infection (KP-BSI) has been reported to account for more than 10% of all KP-BSI, but few studies have characterized polymicrobial KP-BSI. Our study investigated the clinical characteristics, risk factors, and outcomes of polymicrobial KP-BSI by comparing with monomicrobial KP-BSI. Methods. We conducted a single-center retrospective cohort study of patients with KP-BSI from 1 January 2013 to 31 December 2018 and collected the clinical data by reviewing electronic medical records. Results. Of the 818 patients with KP-BSI recruited, 13.9% (114/818) were polymicrobial KP-BSI. The severity of illness in polymicrobial and monomicrobial KP-BSI was similar, while the rate of resistance to carbapenems was obviously higher in polymicrobial KP-BSI (78.1% vs. 65.6%, p=0.009). On multivariate analysis, hospitalization in burn ward (odds ratio (OR) 6.13, 95% confidence interval (CI) 2.00-18.76, p=0.001) and intensive care unit (OR 2.39, 95% CI 1.05-5.43, p=0.038) was independently associated with polymicrobial KP-BSI. Gram-negative bacteria accounted for the highest proportion (68.9%) among copathogens of polymicrobial KP-BSI, whereas gram-positive bacteria (22.9%) and Candida (8.2%) ranked the second and the third, respectively, with Acinetobacter baumannii being the most common (23.0%). Patients with polymicrobial KP-BSI had longer hospital days after BSI onset and total hospital days than patients with monomicrobial KP-BSI (median (interquartile range (IQR)), 19 (5, 39) vs. 12 (6, 25), 37 (21, 67) vs. 29 (16, 53), respectively, p0.05). Conclusions. It was observed that polymicrobial KP-BSI accounted for a significant proportion among all KP-BSI in the current study. Hospitalization in burn ward and intensive care unit was an independent risk factor for the development of polymicrobial KP-BSI. The patients with polymicrobial KP-BSI had a higher rate of carbapenem-resistant K. pneumoniae and might have poor outcomes compared to monomicrobial KP-BSI.