Clinical Characteristics and Independent Risk Factors for Multidrug-Resistant Klebsiella pneumoniae Bloodstream Infections: A Retrospective Analysis from China

Panpan Xu,1,* Yifeng Mao,1,* Qingqing Chen,2,3,* Xinhua Luo,4 Ronghai Lin,1 Cheng Zheng1 1Department of Critical Care Medicine, Taizhou Municipal Hospital (Taizhou University Affiliated Municipal Hospital), School of Medicine, Taizhou University, Taizhou, Zhejiang, 318000, People’s Republic of China; 2Rehabilitation Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 318000, People’s Republic of China; 3Neurorehabilitation Center, Taizhou Rehabilitation Hospital, Taizhou Enze Medical Center (Group), Taizhou, Zhejiang, 318000, People’s Republic of China; 4Department of Clinical Microbiology Laboratory, Taizhou Municipal Hospital (Taizhou University Affiliated Municipal Hospital), School of Medicine, Taizhou University, Taizhou, Zhejiang, 318000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Cheng Zheng, Department of Critical Care Medicine, Taizhou Municipal Hospital (Taizhou University Affiliated Municipal Hospital), School of Medicine, Taizhou University, Taizhou, Zhejiang, 318000, People’s Republic of China, Email [email protected] Ronghai Lin, Department of Critical Care Medicine, Taizhou Municipal Hospital (Taizhou University Affiliated Municipal Hospital), School of Medicine, Taizhou University, Taizhou, Zhejiang, 318000, People’s Republic of China, Email [email protected]: This study aimed to analyze the clinical characteristics and risk factors of multidrug-resistant Klebsiella pneumoniae bloodstream infections (MDR KP-BSI) compared to non-MDR KP-BSI among adult patients in China, providing guidance for clinicians to prevent MDR KP-BSI.Patients and Methods: A retrospective analysis of 240 adult patients with KP-BSI (2019– 2023) was conducted. Clinical data were analyzed using multivariable logistic regression to identify risk factors.Results: MDR KP-BSI prevalence was 22.5% (54/240). The MDR KP-BSI group had higher rates of comorbidities (hemiplegia, COPD/severe asthma, chronic cardiac insufficiency, cerebrovascular accident) and higher disease severity scores (APACHE II, SOFA, Pitt bacteremia, Charlson index, all P< 0.05). Treatment-related factors (antibiotic exposure, ICU admission, nutrition support, invasive procedures) were more frequent in the MDR KP-BSI group (P< 0.05). Pulmonary origin was significantly more common (42.6% vs 12.4%, P< 0.05), while liver origin was less common (1.9% vs 24.2%, P< 0.05) in MDR versus non-MDR KP-BSI. MDR KP-BSI patients had significantly worse outcomes: higher 7-day (40.7% vs 11.8%, P< 0.001), 14-day (35.2% vs 10.8%, P< 0.001), and 28-day mortality (27.8% vs 8.6%, P< 0.001), and prolonged hospitalization [26.5 days (14.0, 64.5) vs 13.0 days (8.0, 23.0), P< 0.001]. Multivariable analysis identified independent risk factors: recent antibiotic exposure (adjusted OR [aOR] 7.025; 95% CI 2.695– 18.313), cerebrovascular accident history (aOR 3.095; 95% CI 1.054– 9.903), and pulmonary infection source (aOR 2.941; 95% CI 1.101– 7.895).Conclusion: These predictors emphasize the need for antibiotic stewardship, infection control, and early interventions in high-risk patients to reduce MDR KP-BSI incidence.Keywords: Klebsiella pneumoniae, multidrug-resistant, bloodstream infections, risk factors