Healthcare-associated carbapenem-resistant Klebsiella pneumoniae infections are associated with higher mortality compared to carbapenem-sensitive K. pneumoniae infections in the ICU: a retrospective cohort study.

BACKGROUND: We aimed to investigate the association between carbapenem resistance and the mortality rate, length of stay, and hospital cost in patients with Klebsiella pneumoniae infection.

METHODS: The retrospective cohort study was conducted in the intensive care units of a large teaching tertiary hospital in southwest China between 1st January 2020 and 31st December 2022. To examine the impact of carbapenem resistance on mortality rates and economic burden, multivariate COX regression and generalised linear models were constructed.

RESULTS: The study included 282 adult patients with KP infection (135 carbapenem-sensitive KP [CSKP]; 147 carbapenem-resistant KP [CRKP] infection). CRKP-infected patients demonstrated a higher mortality risk (unadjusted hazard ratio = 1.980; 95% CI 1.206-3.248; P 0.007; adjusted hazard ratio = 1.767; 95% CI 1.038-3.005; P 0.036) compared to CSKP-infected patients. Stratified analysis, according to the type of KP infection, revealed that patients with healthcare-associated CRKP infection showed a significantly higher risk of mortality compared to those with CSKP infection (Log-rank P=0.015). Moreover, patients with CRKP infection had longer hospital stays than those infected with CSKP (adjusted mean 38.74 days vs. 29.71 days; P 0.003), and the hospital-related expenses were notably higher among CRKP patients than CSKP patients (adjusted cost: GBP 40,126.73 vs. 25,713.74; P <0.001).

CONCLUSIONS: CRKP infections increase mortality rates, prolong hospital stays, and raise healthcare costs. Consequently, it would be prudent for healthcare facilities to adopt targeted strategies, including curtailing pre-infection hospitalisation periods and managing medications more judiciously.