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

Abstract

Purpose: 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.