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Clinical Characteristics and Risk Factors for Bloodstream Infection Due to Carbapenem-Resistant Klebsiella pneumoniae in Patients with Hematologic Malignancies

Authors Zhang P, Wang J, Hu H, Zhang S, Wei J, Yang Q, Qu T

Received 17 July 2020

Accepted for publication 8 September 2020

Published 22 September 2020 Volume 2020:13 Pages 3233—3242

DOI https://doi.org/10.2147/IDR.S272217

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Sahil Khanna


Piaopiao Zhang,1 Jie Wang,2 Hangbin Hu,1 Sheng Zhang,3 Juying Wei,4 Qing Yang,1 Tingting Qu1

1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Respiratory Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 3Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 4Hematological Diseases Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China

Correspondence: Tingting Qu
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun East Road, Hangzhou 310001, People’s Republic of China
Tel/Fax +86 57187236673
Email qutingting@zju.edu.cn

Purpose: The aim was to examine the clinical characteristics and risk factors for bloodstream infection (BSI) due to carbapenem-resistant Klebsiella pneumoniae (CRKP) in patients with hematologic malignancies.
Materials and Methods: A single-centre, retrospective case–control study representing 734 patients with hematologic malignancies between January 1, 2017, and December 31, 2018, was conducted. Demographic and clinical data were collected from the hospital electronic medical records system.
Results: Among the 734 patients with hematologic malignancies, 3% (22/734) of the patients developed CRKP BSI during their hospitalization. Overall 28-day all-cause mortality reached 77.3% (17/22). Patients with Pitt bacteremia score (PBS) > 4, pneumonia and septic shock were more frequent in the non-survivors versus the survivors. Compared with the non-survivors in antimicrobial treatment, combination therapy of tigecycline and polymyxin B was more common in the survivors. The independent risk factors associated with CRKP BSI were CRKP rectal colonization (OR, 11.067; CI=4.43– 27.644; P< 0.001; 3 points), severe neutropenia (OR, 4.095; CI=0.876– 19.141; P=0.073; 1 point) and invasive mechanical ventilation (IMV) within the previous 30 days to onset of BSI (OR, 18.444; CI=1.787– 190.343; P=0.014; 4 points). The total risk score of ≥ 5 indicated that the probability of CRKP BSI occurrence was above 48%.
Conclusion: CRKP BSI in patients with hematologic malignancies is associated with high mortality. The risk factor-based prediction model might help clinicians to start prompt effective anti-infective therapy in patients with suspicion of CRKP BSI and improve outcomes.

Keywords: carbapenem-resistant Klebsiella pneumoniae, bloodstream infection, hematologic malignancy, risk factors, prediction

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