Current epidemiology, risk factors and influence on prognosis of multidrug resistance in Klebsiella spp. bloodstream infection. Insights from a prospective cohort.

Abstract

We aimed to describe clinical characteristics, risk factors and prognosis in patients with Klebsiella spp. bacteremia according to their beta-lactam resistance profile. Single-centre prospective cohort, including all adults patients with a first episode of Klebsiella spp. bacteriemia from January 2021 to December 2023. Patients were divided into 2 groups: Klebsiella spp. susceptible to carbapenems (CS-K)); and carbapenem-resistant Klebsiella spp. (CR-K). The primary endpoint for prognosis was 30-day mortality. Of the 186 patients included, 156 (83.9 %) were CS-K, and 30 (16.1 %) CR-K. The only factor independently associated with CR-K was previous known colonization (aOR 353.7, 95 %CI 39.8-3142.5). Thirty-day mortality was higher for CR-K than CS-K (40.0 % vs 10.9 %, p < 0.001). An adequate initial antibiotic was used more frequently in CS-K vs CR-K (75.6 % vs 36.7 %, p < 0.001). After adjusting for possible cofounding factors, CR-K was associated with higher mortality (aOR 3.97, 95 % CI 1.40-9.12). Among CR-K, receiving new beta-lactams/betalactamase inhibitors was independently associated with lower 30-day mortality (aOR 0.10, 95 % CI 0.01-0.91). Those patients had similar mortality than those with carbapenem-susceptible Klebsiella spp. bacteremia (10.9 % vs 16.7 %, p = 0.680) CONCLUSIONS: CR-K bacteremia was associated with worse outcomes. Prior colonization was the most important factor associated with this infection. The use of active new betalactam/betalactamase inhibitor antibiotic in patients with CR-K bacteremia was associated with a better prognosis, matching the 30-day mortality observed in carbapenem-susceptible Klebsiella spp. strains.