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Background  To analyze the clinical characteristics and outcomes of carbapenem-resistant  Klebsiella pneumoniae  (CRKp) and carbapenem-susceptible  K. pneumoniae  (CSKp) bloodstream infections (BSIs), and to study the risk factors for development of CRKp BSI and  K. pneumoniae  BSI-related mortality.    Methods  A retrospective case control study of patients with  K. pneumoniae  BSI was conducted in the intensive care unit of the First Affiliated Hospital, Medical of College, Zhejiang University from January 2013 to December 2014. Carbapenem resistance was defined in accordance with the Clinical and Laboratory Standards Institute 2016 guidelines. Risk factors for the development of CRKp BSI and risk factors for mortality due to  K. pneumoniae  BSI were assessed. Virulence genes were detected by polymerase chain reaction assay.    Results  In total, 48 patients were enrolled in the study, including 31 (65%) patients with CRKp BSI and 17 (35%) patients with CSKp BSI. CSKp infection was associated with more severe clinical symptoms, particularly a higher serum creatinine level (165.06 ± 127.01 in the CSKp group vs. 93.77 ± 84.35 μmol/L in the CRKp group,  p =  0.039), but there was no significant difference in prognosis between the CSKp and CRKp groups. On multivariate analysis, indwelling central venous catheter ( p =  0.045) was the only factor independently associated with CRKp bacteremia. However, the mortality of  K. pneumoniae  BSI patients was not correlated with carbapenem resistance. In addition, the isolates had diverse clonality and different origins. The frequency of detection of the  allS  and  magA  virulence genes was higher in the CSKp group than in the CRKp group ( alls p =  0.04;  magA p =  0.047).    Conclusions  Patients in the CSKp group experienced more severe clinical symptoms, although mortality did not differ significantly between the CRKp and CSKp groups. An indwelling central venous catheter was the only factor independently associated with CRKp BSI. The mortality of patients with  K. pneumoniae  BSI was not associated with carbapenem resistance. The frequency of virulence genes was higher in the CSKp group than in the CRKp group.

antimicrobial resistance and infection control

Clinical and molecular characteristics, risk factors and outcomes of Carbapenem-resistant Klebsiella pneumoniae bloodstream infections in the intensive care unit