Management practices and mortality predictors among Klebsiella pneumoniae infections across Lebanese hospitals: a multicenter retrospective study
Abstract Background Klebsiella pneumoniae is a significant cause of both community-acquired and nosocomial infections, leading to high morbidity and mortality rates. The increasing antimicrobial resistance among K. pneumoniae strains poses a critical challenge to effective treatment. This study aime...
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BMC
2025-04-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-025-11010-5 |
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| author | Rania Itani Hani M. J. Khojah Hamza Raychouni Rahaf Kibrit Patricia Shuhaiber Carole Dib Mariam Hassan Tareq L. Mukattash Abdalla El-Lakany |
| author_facet | Rania Itani Hani M. J. Khojah Hamza Raychouni Rahaf Kibrit Patricia Shuhaiber Carole Dib Mariam Hassan Tareq L. Mukattash Abdalla El-Lakany |
| author_sort | Rania Itani |
| collection | DOAJ |
| description | Abstract Background Klebsiella pneumoniae is a significant cause of both community-acquired and nosocomial infections, leading to high morbidity and mortality rates. The increasing antimicrobial resistance among K. pneumoniae strains poses a critical challenge to effective treatment. This study aimed to assess the appropriateness of initial antimicrobial therapy, determine the 30-day all-cause mortality rate, and identify predictors of mortality among patients infected with K. pneumoniae in Lebanese hospitals. Methods A multicenter retrospective observational study was conducted across three university hospitals in Beirut, Lebanon. The study included hospitalized adult patients with confirmed K. pneumoniae infections. Kaplan-Meier survival analysis and log-rank tests were used to analyze time-to-mortality. Binary logistic regression was performed to identify predictors of mortality. Results Of 2,655 cases screened, 410 patients were enrolled, and 395 cases were included in the final analysis of the 30-day mortality after excluding those lost to follow-up. Nearly one-third of the isolates (36.8%) were extended-spectrum β-lactamase (ESBL)-producing, while 6.8% were carbapenem-resistant K. pneumoniae (CRKP). The most commonly prescribed empirical antibiotics were meropenem (31.7%), amikacin (28.5%), and ceftriaxone (22.2%). Around one-third of the patients (32.9%) received inappropriate initial antimicrobial therapy. The 30-day mortality rate was 14.4%. Main predictors significantly associated with mortality in patients with K. pneumoniae infection were solid cancer (adjusted odds ratio [AOR] = 7.82, P < 0.01), coronary artery disease (AOR = 4.81, P = 0.01), age ≥ 65 years (AOR = 4.22, P = 0.02), type II diabetes mellitus (AOR = 3.96, P = 0.01), receiving inappropriate initial antimicrobial therapy (AOR = 2.96, P = 0.02), infection with CRKP isolates (AOR = 2.53, P = 0.03), and having a higher Charlson comorbidity index (AOR = 1.61, P = 0.001). Conclusions The study highlights the critical need for effective antimicrobial stewardship and tailored infection control protocols to mitigate the high resistance rates and improve patient outcomes in Lebanon. Emphasis should be placed on enhancing the monitoring of local resistance patterns and using these data to guide the selection of appropriate empirical therapy to reduce mortality associated with K. pneumoniae infections. |
| format | Article |
| id | doaj-art-24d3f00e1bfa4f4fa8ff68874a24c2f0 |
| institution | OA Journals |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-24d3f00e1bfa4f4fa8ff68874a24c2f02025-08-20T01:47:33ZengBMCBMC Infectious Diseases1471-23342025-04-0125111510.1186/s12879-025-11010-5Management practices and mortality predictors among Klebsiella pneumoniae infections across Lebanese hospitals: a multicenter retrospective studyRania Itani0Hani M. J. Khojah1Hamza Raychouni2Rahaf Kibrit3Patricia Shuhaiber4Carole Dib5Mariam Hassan6Tareq L. Mukattash7Abdalla El-Lakany8Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab UniversityDepartment of Pharmacy Practice, College of Pharmacy, Taibah UniversityIntensive Care Unit, Anesthesia Department, Central Military Hospital, Military HealthcarePharmacy Department, Lebanese Hospital Geitaoui University Medical CenterPharmacy Department, Mount Lebanon Hospital Balamand University Medical CenterPharmacy Department, Lebanese Hospital Geitaoui University Medical CenterEmergency Department, Sahel General HospitalDepartment of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and TechnologyDepartment of Pharmaceutical Sciences, Faculty of Pharmacy, Beirut Arab UniversityAbstract Background Klebsiella pneumoniae is a significant cause of both community-acquired and nosocomial infections, leading to high morbidity and mortality rates. The increasing antimicrobial resistance among K. pneumoniae strains poses a critical challenge to effective treatment. This study aimed to assess the appropriateness of initial antimicrobial therapy, determine the 30-day all-cause mortality rate, and identify predictors of mortality among patients infected with K. pneumoniae in Lebanese hospitals. Methods A multicenter retrospective observational study was conducted across three university hospitals in Beirut, Lebanon. The study included hospitalized adult patients with confirmed K. pneumoniae infections. Kaplan-Meier survival analysis and log-rank tests were used to analyze time-to-mortality. Binary logistic regression was performed to identify predictors of mortality. Results Of 2,655 cases screened, 410 patients were enrolled, and 395 cases were included in the final analysis of the 30-day mortality after excluding those lost to follow-up. Nearly one-third of the isolates (36.8%) were extended-spectrum β-lactamase (ESBL)-producing, while 6.8% were carbapenem-resistant K. pneumoniae (CRKP). The most commonly prescribed empirical antibiotics were meropenem (31.7%), amikacin (28.5%), and ceftriaxone (22.2%). Around one-third of the patients (32.9%) received inappropriate initial antimicrobial therapy. The 30-day mortality rate was 14.4%. Main predictors significantly associated with mortality in patients with K. pneumoniae infection were solid cancer (adjusted odds ratio [AOR] = 7.82, P < 0.01), coronary artery disease (AOR = 4.81, P = 0.01), age ≥ 65 years (AOR = 4.22, P = 0.02), type II diabetes mellitus (AOR = 3.96, P = 0.01), receiving inappropriate initial antimicrobial therapy (AOR = 2.96, P = 0.02), infection with CRKP isolates (AOR = 2.53, P = 0.03), and having a higher Charlson comorbidity index (AOR = 1.61, P = 0.001). Conclusions The study highlights the critical need for effective antimicrobial stewardship and tailored infection control protocols to mitigate the high resistance rates and improve patient outcomes in Lebanon. Emphasis should be placed on enhancing the monitoring of local resistance patterns and using these data to guide the selection of appropriate empirical therapy to reduce mortality associated with K. pneumoniae infections.https://doi.org/10.1186/s12879-025-11010-5Klebsiella pneumoniaeAntimicrobial drug resistanceESBL-producingCarbapenem-resistantAntibiogramAntibiotics |
| spellingShingle | Rania Itani Hani M. J. Khojah Hamza Raychouni Rahaf Kibrit Patricia Shuhaiber Carole Dib Mariam Hassan Tareq L. Mukattash Abdalla El-Lakany Management practices and mortality predictors among Klebsiella pneumoniae infections across Lebanese hospitals: a multicenter retrospective study BMC Infectious Diseases Klebsiella pneumoniae Antimicrobial drug resistance ESBL-producing Carbapenem-resistant Antibiogram Antibiotics |
| title | Management practices and mortality predictors among Klebsiella pneumoniae infections across Lebanese hospitals: a multicenter retrospective study |
| title_full | Management practices and mortality predictors among Klebsiella pneumoniae infections across Lebanese hospitals: a multicenter retrospective study |
| title_fullStr | Management practices and mortality predictors among Klebsiella pneumoniae infections across Lebanese hospitals: a multicenter retrospective study |
| title_full_unstemmed | Management practices and mortality predictors among Klebsiella pneumoniae infections across Lebanese hospitals: a multicenter retrospective study |
| title_short | Management practices and mortality predictors among Klebsiella pneumoniae infections across Lebanese hospitals: a multicenter retrospective study |
| title_sort | management practices and mortality predictors among klebsiella pneumoniae infections across lebanese hospitals a multicenter retrospective study |
| topic | Klebsiella pneumoniae Antimicrobial drug resistance ESBL-producing Carbapenem-resistant Antibiogram Antibiotics |
| url | https://doi.org/10.1186/s12879-025-11010-5 |
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