Abstract
Aim: In recent years, Klebsiella pneumoniae bloodstream infections (KP-BSIs) have emerged as a major public health concern due to their increasing prevalence and their strong association with high morbidity and mortality rates. Despite this growing threat, there is a lack of epidemiological data specific to Bolu province, Turkey. This study aims to characterize the epidemiological, microbiological, and clinical features of KP-BSIs in this region, with a particular focus on identifying risk factors associated with carbapenem resistance and patient mortality.
Methods: A total of 142 patients with KP-BSIs that developed in the intensive care unit (ICU) over approximately four years were included in the study. The association between demographic and clinical data of the patients and carbapenem resistance and mortality was analyzed.
Results: Among the patients monitored in the intensive care unit, 64.8% died. No independent predictors were identified for the development of carbapenem-resistant K. pneumoniae infections in the multivariate analysis. However, the following factors were found to be associated with an increased risk of mortality: age over 65 years, the presence of pneumonia or a urinary tract infection a bloodstream infection linked to an intravenous catheter, prior use of a central venous catheter, hospitalisation within the last three months, recent or prolonged exposure to broad-spectrum antibiotics, and infections at other anatomical sites. Notably, having a tracheostomy was associated with a reduced risk of death, while a one-unit increase in albumin was associated with a 13.8% lower risk of death, a one-unit increase in C-reactive protein (CRP) was associated with a 1.9% higher risk.
Conclusions: This study provides important data on the rate of KP-BSI isolated from secondary care facilities and the risk factors for mortality. Existing literature has typically focused on identifying risk factors for death in tertiary care public hospitals. However, this study examined the intensive care units of secondary care public hospitals and found high mortality rates among patients. The high mortality rate of patients with KP-BSI highlights the urgency of implementing appropriate infection control strategies
Keywords: Klebsiella pneumoniae, bloodstream infection, mortality
Copyright and license
Copyright © 2025 The Author(s). This is an open-access article published by Bolu İzzet Baysal Training and Research Hospital under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
How to cite
References
- Rodríguez-Baño J, Pascual A. Clinical significance of extended-spectrum beta-lactamases. Expert Rev Anti Infect Ther. 2008; 6(5): 671-83. https://doi.org/10.1586/14787210.6.5.671
- Tumbarello M, Spanu T, Di Bidino R, et al. Costs of bloodstream infections caused by Escherichia coli and influence of extended-spectrum-beta-lactamase production and inadequate initial antibiotic therapy. Antimicrob Agents Chemother. 2010; 54(10): 4085-91. https://doi.org/10.1128/AAC.00143-10
- Giske CG, Monnet DL, Cars O, Carmeli Y; ReAct-Action on Antibiotic Resistance. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother. 2008; 52(3): 813-21. https://doi.org/10.1128/AAC.01169-07
- Hirsch EB, Tam VH. Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): an emerging cause of multidrug-resistant infection. J Antimicrob Chemother. 2010; 65(6): 1119-25. https://doi.org/10.1093/jac/dkq108
- Tumbarello M, Viale P, Viscoli C, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy. Clin Infect Dis. 2012; 55(7): 943-50. https://doi.org/10.1093/cid/cis588
- Qureshi ZA, Paterson DL, Potoski BA, et al. Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens. Antimicrob Agents Chemother. 2012; 56(4): 2108-13. https://doi.org/10.1128/AAC.06268-11
- Viale P, Giannella M, Lewis R, Trecarichi EM, Petrosillo N, Tumbarello M. Predictors of mortality in multidrug-resistant Klebsiella pneumoniae bloodstream infections. Expert Rev Anti Infect Ther. 2013; 11(10): 1053-63. https://doi.org/10.1586/14787210.2013.836057
- The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Available at: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_14.0_Breakpoint_Tables.xlsx
- Wang Z, Qin RR, Huang L, Sun LY. Risk Factors for Carbapenem-resistant Klebsiella pneumoniae Infection and Mortality of Klebsiella pneumoniae Infection. Chin Med J (Engl). 2018; 131(1): 56-62. https://doi.org/10.4103/0366-6999.221267
- Liu P, Li X, Luo M, et al. Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection: A Meta-Analysis. Microb Drug Resist. 2018; 24(2): 190-8. https://doi.org/10.1089/mdr.2017.0061
- Li J, Li Y, Song N, Chen Y. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection: A meta-analysis. J Glob Antimicrob Resist. 2020; 21: 306-13. https://doi.org/10.1016/j.jgar.2019.09.006
- Vardakas KZ, Matthaiou DK, Falagas ME, Antypa E, Koteli A, Antoniadou E. Characteristics, risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in the intensive care unit. J Infect. 2015; 70(6): 592-9. https://doi.org/10.1016/j.jinf.2014.11.003
- Büyüktuna SA, Hasbek M, Çelik C, et al. Klebsiella pneumoniae Infections in the Intensive Care Unit: Risk Factors Related to Carbapenem Resistance and Patient Mortality. Mikrobiyol Bul. 2020; 54(3): 378-91. https://doi.org/10.5578/mb.69679
- Durdu B, Hakyemez IN, Bolukcu S, Okay G, Gultepe B, Aslan T. Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection. Springerplus. 2016; 5(1): 1892. https://doi.org/10.1186/s40064-016-3580-8
- Delle Rose D, Sordillo P, Gini S, et al. Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals. Am J Infect Control. 2015; 43(11): 1178-83. https://doi.org/10.1016/j.ajic.2015.06.023
- Cekin ZK, Oncul A, Bayraktar B. Bloodstream Infections Caused by Multidrug Resistant Bacteria: Clinical and Microbiological Features and Mortality. Sisli Etfal Hastan Tıp Bul. 2023; 57(3): 416-25. https://doi.org/10.14744/SEMB.2023.31697
- Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA. The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med. 2008; 36(9): 2547-57. https://doi.org/10.1097/CCM.0b013e31818444a5
- Flaatten H, Gjerde S, Heimdal JH, Aardal S. The effect of tracheostomy on outcome in intensive care unit patients. Acta Anaesthesiol Scand. 2006; 50(1): 92-8. https://doi.org/10.1111/j.1399-6576.2005.00898.x
- Marsik C, Kazemi-Shirazi L, Schickbauer T, et al. C-reactive protein and all-cause mortality in a large hospital-based cohort. Clin Chem. 2008; 54(2): 343-9. https://doi.org/10.1373/clinchem.2007.091959
- Chen PL, Li ZH, Yang HL, et al. Associations Between High-Sensitivity C-Reactive Protein and All-Cause Mortality Among Oldest-Old in Chinese Longevity Areas: A Community-Based Cohort Study. Front Public Health. 2022; 10: 824783. https://doi.org/10.3389/fpubh.2022.824783
- Jin X, Li J, Sun L, et al. Prognostic Value of Serum Albumin Level in Critically Ill Patients: Observational Data From Large Intensive Care Unit Databases. Front Nutr. 2022; 9: 770674. https://doi.org/10.3389/fnut.2022.770674
- Yang K, Yang N, Sun W, et al. The association between albumin and mortality in patients with acute kidney injury: a retrospective observational study. BMC Nephrol. 2023; 24(1): 332. https://doi.org/10.1186/s12882-023-03323-x