We aimed to compare efficacy of different patterns of antibiotics and explore the risk factors related to mortality in patients with bloodstream infections (BSIs) due to carbapenem-resistant Klebsiella pneumoniae (CRKP). This study retrospectively included 89 patients with BSIs due to CRKP with complete data during the year of 2018 in the First Affiliated Hospital of Zhejiang University School of Medicine. Overall, the 28-day mortality was 47.2% (42/89). Multivariate analysis of Cox regression revealed that hematological malignancy (hazard ratio [HR] 5.698; 95% confidence interval [CI], 2.405–13.504; p < 0.001) and Pitt bacteremia score (HR per unit increase, 1.303; 95% CI, 1.109–1.532; p = 0.001) were identified as independent predictors for 28-day mortality. Among 70 patients with appropriate therapy, 35 received tigecycline (TGC)-based therapy, 20 received polymyxin B (PMB)-based therapy, 9 received ceftazidime/avibactam-based therapy, and 6 patients had other kinds of antibiotics, including ciprofloxacin, amikacin, and cotrimoxazole. By adjusting variables selected by crude analysis, it showed that receiving PMB-based therapy provided a survival benefit comparing with TGC-based therapy (HR, 0.068; 95% CI, 0.018–0.260; p < 0.001). Hematological malignancy and Pitt bacteremia score were independent risk factors of death in patients with BSIs due to CRKP and PMB-based therapy improved survival rate compared with TGC-based therapy.

中文翻译：

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耐碳青霉烯类肺炎克雷伯菌引起的血流感染：危险因素和治疗选择的单中心回顾性研究

我们旨在比较不同类型抗生素的疗效，并探讨与耐碳青霉烯类肺炎克雷伯菌(CRKP)导致的血流感染(BSI)患者死亡率相关的危险因素。本研究回顾性纳入浙江大学医学院附属第一医院2018年89例CRKP所致BSI患者，资料完整。总体而言，28 天死亡率为 47.2% (42/89)。Cox 回归的多变量分析显示血液恶性肿瘤（风险比 [HR] 5.698；95% 置信区间 [CI]，2.405-13.504；p  < 0.001）和 Pitt 菌血症评分（每单位增加的 HR，1.303；95% CI，1.109 –1.532; p = 0.001) 被确定为 28 天死亡率的独立预测因子。70例接受适当治疗的患者中，35例接受以替加环素（TGC）为基础的治疗，20例接受以多粘菌素B（PMB）为基础的治疗，9例接受以头孢他啶/阿维巴坦为基础的治疗，6例接受其他抗生素治疗，包括环丙沙星、阿米卡星和复方新诺明。通过调整粗略分析选择的变量，结果表明，与基于 TGC 的治疗相比，接受基于 PMB 的治疗提供了生存获益（HR，0.068；95% CI，0.018–0.260；p  < 0.001）。血液系统恶性肿瘤和 Pitt 菌血症评分是 CRKP 所致 BSI 患者死亡的独立危险因素，与基于 TGC 的治疗相比，基于 PMB 的治疗可提高生存率。