Clinical characteristics and risk factors of catheter-associated urinary tract infections caused by Klebsiella Pneumoniae

Abstract

BACKGROUND: The clinical characteristics and risk factors of catheter-associated urinary tract infections (CAUTIs) caused by Klebsiella pneumoniae (KP) have not been well investigated. METHODS: This retrospective study performed at a university teaching hospital in China from January 2012 to November 2017 analyzed data for 227 patients with urinary tract infection (UTI) caused by KP. Patients' demographic characteristics and clinical outcomes were recorded. Risk factors were analyzed using a binary logistic regression model. RESULTS: Of 227 patients with Klebsiella pneumoniae-related urinary tract Infection (KP-UTI), the infection was catheter-associated in 90 patients. More than half of them were male (60%), over 60 years old, hospitalized in general ward, always acquired in hospital, and got a longer hospitalization more than one month. The Klebsiella pneumoniae-related catheter-associated urinary tract infections (KP-CAUTIs) patients always combined with lots of chronic comorbidities. A high proportion of invasive device, extendedspectrum β-lactamase (ESBL) expression and multidrug resistance (MDR) were found in KP-CAUTIs patients. When taken antimicrobial activity into consideration, KP-CAUTIs patients performed resistance to most antibiotics in varying degrees. Logistic regression analysis revealed that after grouping by ESBL expression and in-hospital mortality among patients with KP-CAUTI, complicated urinary tract infection (cUTI) was an independent risk factor for ESBL positive KP-CAUTIs [odds ratio (OR) 59.256; 95% CI, 3.417-1,027.628; P=0.005], whereas congestive heart failure was identified as an independent risk factor for in-hospital mortality (OR 25.592; 95% CI, 2.376-275.629; P=0.008) in KP-CAUTI patients. CONCLUSIONS: Patients with KP-CAUTI displayed distinctive characteristics. cUTI and congestive heart failure were independently associated with ESBL expression and in-hospital mortality in patients with KPCAUTI.