There are few studies focused on carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI). The aim of this study is to identify the prevalence and risk factors for infection and mortality of CRKP BSI. Susceptibility of Klebsiella pneumoniae (KP) isolated from blood samples and the proportion of CRKP were recorded annually. One hundred sixty-four patients with CRKP and 328 with carbapenem-susceptible Klebsiella pneumoniae (CSKP) BSI were categorized as the case group and control group to identify risk factors for CRKP infection and mortality by univariable analysis and multivariable logistic-regression analysis. The proportion and mortality of CRKP BSI increased significantly, with the percentage of KP in BSI increasing from 7 to 12% from 2014 to 2019 with a concomitant resistance to meropenem increasing from 16.7 to 41.8%. Compared with CSKP group, patients in CRKP group had longer hospitalization time before bacteremia (median 14 vs 4, P < 0.001) and longer total hospitalization time (median 31 vs 19, P < 0.001). The proportion of admission to ICU was higher (70.7% vs 17.7%, P < 0.001), and APACHE II score was higher (median 12 vs 8, P < 0.001). The mortality in CRKP group was 43.9% (72/164), while 14.9% (49/328) in CSKP group (p < 0.001). KP detection in other sites(P = 0.036, OR 1.964), blood purification(P = 0.018, OR 3.326), bronchoscopy(P = 0.011, OR 5.423), surgery (P = 0.001, OR 3.084), carbapenem use(P = 0.001, OR 3.395), tigecycline use(P = 0.006, OR 4.595) were independent risk factors for CRKP BSI. Previous hospitalization (P = 0.048, OR 2.755), long hospitalization (P = 0.003, OR 1.035), bone marrow puncture (P = 0.037, OR3.856), use of β-lactamase inhibitor (P = 0.005, OR 3.890) were independent risk factors for mortality in CRKP BSI. The prevalence and mortality of CRKP BSI are still increasing. Timely treatment of KP infection in other site, strengthening the hospital infection control of blood purification, bronchoscopy and surgery, control the use of carbapenem and tigecycline, may help to prevent CRKP BSI. More preventative hospital resources are needed for severely ill patients with prolonged hospitalizations and intensive care.

中文翻译：

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在华北一家三级医院中，对碳青霉烯耐药的肺炎克雷伯菌的血液感染的感染率和危险因素的五年变化和死亡率。

很少有研究针对耐碳青霉烯的肺炎克雷伯菌（CRKP）血流感染（BSI）。本研究的目的是确定CRKP BSI感染和死亡的患病率和危险因素。每年记录从血液样本中分离出的肺炎克雷伯菌（KP）的易感性和CRKP的比例。164例CRKP患者和328例碳青霉烯易感性肺炎克雷伯氏菌（CSKP）BSI患者被分为病例组和对照组，以通过单变量分析和多因素Logistic回归分析确定CRKP感染和死亡的危险因素。从2014年到2019年，CRKP BSI的比例和死亡率显着增加，KP在BSI中的比例从7％增加到12％，同时对美罗培南的抵抗力从16.7增加到41.8％。与CSKP组相比，CRKP组的患者发生菌血症前的住院时间更长（中位14 vs 4，P <0.001），总住院时间更长（中位31 vs 19，P <0.001）。重症监护病房入院的比例更高（70.7％比17.7％，P <0.001），APACHE II评分更高（中位数12比8，P <0.001）。CRKP组的死亡率为43.9％（72/164），而CSKP组的死亡率为14.9％（49/328）（p <0.001）。在其他部位进行KP检测（P = 0.036，OR 1.964），血液净化（P = 0.018，OR 3.326），支气管镜检查（P = 0.011，OR 5.423），手术（P = 0.001，OR 3.084），碳青霉烯的使用（P = 0.001，OR 3.395），使用替加环素（P = 0.006，OR 4.595）是CRKP BSI的独立危险因素。既往住院（P = 0.048，OR 2.755），长期住院（P = 0.003，OR 1.035），骨髓穿刺（P = 0.037，OR3.856），使用β-内酰胺酶抑制剂（P = 0.005，或3.890）是CRKP BSI死亡率的独立危险因素。CRKP BSI的患病率和死亡率仍在增加。及时治疗其他部位的KP感染，加强医院感染的血液净化控制，支气管镜检查和手术，控制碳青霉烯和替加环素的使用，可能有助于预防CRKP BSI。对于住院时间较长和重症监护的重症患者，需要更多的预防性医院资源。控制碳青霉烯和替加环素的使用，可能有助于预防CRKP BSI。对于住院时间较长和重症监护的重症患者，需要更多的预防性医院资源。控制碳青霉烯和替加环素的使用，可能有助于预防CRKP BSI。对于住院时间较长和重症监护的重症患者，需要更多的预防性医院资源。