Xiao T, et al. - Concerning carbapenem-nonsusceptible Klebsiella pneumoniae (CnSKP) to be a rapidly emerging life-threatening nosocomial infection, researchers assessed the efficacy of tigecycline in the treatment of bloodstream infections (BSIs). The incidence of CnSKP-BSIs significantly increased during the study period. These patients showed a higher mortality rate. For the development of CnSKP-BSIs, exposure to carbapenems and severe illness were noted to be independent risk factors. Tigecycline therapy was observed to result in a significant increase in mortality.

Methods

• Researchers collected data from a total of 428 patients with carbapenem-susceptible Klebsiella pneumoniae (CSKP) and CnSKP BSIs at a single center between January 2013 and December 2015.  
• They performed a three-part analysis to determine the risk factors associated with CnSKP, explore prognosis, and evaluate treatments.

Results

• Researchers included data from 428 patients with Klebsiella pneumoniae (KP) BSIs; 31.5% (n=135) of them had CnSKP.
• In multivariate analysis, prior hospitalization, urinary catheterization, the use of immunosuppressive agents, prior use of antibiotics, pulmonary disease, and high Acute Physiology and Chronic Health Evaluation (APACHE) II scores were identified to be independent risk factors for CnSKP-BSIs.
• Patients with CnSKP showed higher 30-day mortality than those with CSKP (58.5% vs 15.4%; P<0.001).
• Neutropenia, multiple organ dysfunction, respiratory failure, CnSKP infection, high APACHE II score, and tigecycline therapy were identified to have independent association with higher mortality risk among patients with KP-BSIs.
• They observed higher mortality rates in patients treated with tigecycline than those treated with other antibiotics among patients whose APACHE II score was <15(45.3% vs 7.7%; P < 0.001).
• Independent risk factors for death from CnSKP included central venous catheterization, multiple organ dysfunction, and high APACHE II scores.