Risk factors for bloodstream infection and predictors of prognosis in rectal carriers of carbapenem-resistant Klebsiella pneumoniae
Abstract Background The mortality rate of secondary bloodstream infection (BSI) derived from the intestinal colonization of carbapenem-resistant Klebsiella pneumoniae (CRKP) is extremely high. This investigation aimed at clarifying the risk factors and prognosis of BSIs resulting from the initial co...
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BMC
2025-08-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-025-11472-7 |
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| author | Miaomiao Wu Danhong Yang Xi Li Yicheng Huang Hongying Pan |
| author_facet | Miaomiao Wu Danhong Yang Xi Li Yicheng Huang Hongying Pan |
| author_sort | Miaomiao Wu |
| collection | DOAJ |
| description | Abstract Background The mortality rate of secondary bloodstream infection (BSI) derived from the intestinal colonization of carbapenem-resistant Klebsiella pneumoniae (CRKP) is extremely high. This investigation aimed at clarifying the risk factors and prognosis of BSIs resulting from the initial colonisation of CRKP. Methods In this retrospective, cross-sectional study, we analyzed the clinical data of 167 patients with CRKP colonization who received active screening during hospitalization at Zhejiang Provincial People’s Hospital from January 2019 to December 2021. The cohort consisted of 34 patients with BSI (CRKP BSI group) and 133 patients without BSI (No-BSI CRKP group).Logistic regression was employed to identify risk factors for progression from CRKP intestinal colonization to secondary BSI.Cox proportional hazards regression models were used to analyze independent risk factors for 28-day crude mortality from CRKP BSI. Results Multivariable analysis revealed that previous use of carbapenems (odds ratio [OR]:4.14, 95% confidence interval [CI]: 1.07–16.0, P = 0.040), corticosteroid use (OR: 3.18, 95% CI: 1.16–8.74, P = 0.025), and agranulocytosis (OR: 7.54, 95% CI: 2.09–27.2; P = 0.002) were independent risk factors for BSI in patients with CRKP rectal colonization. The overall mortality rate for CRKP infection was 20.4% (34/167), and the crude 28-day mortality rate for CRKP BSI was 44.1% (15/34), which was independently associated with hematologic neoplasms (P < 0.001). Among the 11 genotypically evaluated CRKP strains, 10 harbored the bla KPC−2 gene. Conclusions Neutrophil deficiency, previous use of carbapenems, and corticosteroid use are risk factors for BSI following CRKP colonization. Patients with hematologic neoplasms associated with CRKP infection are at high risk of death. Patients with clinical risk factors should be identified early, and targeted intervention measures should be taken to optimize antibiotic use and reduce the risk of subsequent BSI. |
| format | Article |
| id | doaj-art-b4ec714b026c4e708c5fc877d42d56dc |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-b4ec714b026c4e708c5fc877d42d56dc2025-08-24T11:09:58ZengBMCBMC Infectious Diseases1471-23342025-08-012511910.1186/s12879-025-11472-7Risk factors for bloodstream infection and predictors of prognosis in rectal carriers of carbapenem-resistant Klebsiella pneumoniaeMiaomiao Wu0Danhong Yang1Xi Li2Yicheng Huang3Hongying Pan4Department of Infectious Diseases, Shanghai Tenth People’s Hospital, Tongji University School of MedicineDepartment of Infectious Diseases, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical CollegeCentre of Laboratory Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical CollegeDepartment of Infectious Diseases, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical CollegeDepartment of Infectious Diseases, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical CollegeAbstract Background The mortality rate of secondary bloodstream infection (BSI) derived from the intestinal colonization of carbapenem-resistant Klebsiella pneumoniae (CRKP) is extremely high. This investigation aimed at clarifying the risk factors and prognosis of BSIs resulting from the initial colonisation of CRKP. Methods In this retrospective, cross-sectional study, we analyzed the clinical data of 167 patients with CRKP colonization who received active screening during hospitalization at Zhejiang Provincial People’s Hospital from January 2019 to December 2021. The cohort consisted of 34 patients with BSI (CRKP BSI group) and 133 patients without BSI (No-BSI CRKP group).Logistic regression was employed to identify risk factors for progression from CRKP intestinal colonization to secondary BSI.Cox proportional hazards regression models were used to analyze independent risk factors for 28-day crude mortality from CRKP BSI. Results Multivariable analysis revealed that previous use of carbapenems (odds ratio [OR]:4.14, 95% confidence interval [CI]: 1.07–16.0, P = 0.040), corticosteroid use (OR: 3.18, 95% CI: 1.16–8.74, P = 0.025), and agranulocytosis (OR: 7.54, 95% CI: 2.09–27.2; P = 0.002) were independent risk factors for BSI in patients with CRKP rectal colonization. The overall mortality rate for CRKP infection was 20.4% (34/167), and the crude 28-day mortality rate for CRKP BSI was 44.1% (15/34), which was independently associated with hematologic neoplasms (P < 0.001). Among the 11 genotypically evaluated CRKP strains, 10 harbored the bla KPC−2 gene. Conclusions Neutrophil deficiency, previous use of carbapenems, and corticosteroid use are risk factors for BSI following CRKP colonization. Patients with hematologic neoplasms associated with CRKP infection are at high risk of death. Patients with clinical risk factors should be identified early, and targeted intervention measures should be taken to optimize antibiotic use and reduce the risk of subsequent BSI.https://doi.org/10.1186/s12879-025-11472-7Carbapenem-resistant Klebsiella pneumoniaeBloodstream infectionRectal colonizationRisk factorsPrognosis |
| spellingShingle | Miaomiao Wu Danhong Yang Xi Li Yicheng Huang Hongying Pan Risk factors for bloodstream infection and predictors of prognosis in rectal carriers of carbapenem-resistant Klebsiella pneumoniae BMC Infectious Diseases Carbapenem-resistant Klebsiella pneumoniae Bloodstream infection Rectal colonization Risk factors Prognosis |
| title | Risk factors for bloodstream infection and predictors of prognosis in rectal carriers of carbapenem-resistant Klebsiella pneumoniae |
| title_full | Risk factors for bloodstream infection and predictors of prognosis in rectal carriers of carbapenem-resistant Klebsiella pneumoniae |
| title_fullStr | Risk factors for bloodstream infection and predictors of prognosis in rectal carriers of carbapenem-resistant Klebsiella pneumoniae |
| title_full_unstemmed | Risk factors for bloodstream infection and predictors of prognosis in rectal carriers of carbapenem-resistant Klebsiella pneumoniae |
| title_short | Risk factors for bloodstream infection and predictors of prognosis in rectal carriers of carbapenem-resistant Klebsiella pneumoniae |
| title_sort | risk factors for bloodstream infection and predictors of prognosis in rectal carriers of carbapenem resistant klebsiella pneumoniae |
| topic | Carbapenem-resistant Klebsiella pneumoniae Bloodstream infection Rectal colonization Risk factors Prognosis |
| url | https://doi.org/10.1186/s12879-025-11472-7 |
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