Intensive care unit-acquired pneumonia caused by Klebsiella pneumoniae in China: Risk factors and prediction model of mortality.

Intensive care unit (ICU)-acquired pneumonia (ICUAP) is a major concern owing to its associated high mortality rate. Few studies have focused on ICUAP caused by Klebsiella pneumoniae (KP). This study aimed to investigate the risk factors for ICUAP-associated death due to KP and to develop a mortality prediction model. Patients with KP-associated ICUAP at Renji Hospital were enrolled from January 2012 to December 2017. The patients were registered from the ICU units of the Surgery, Gynecology and Obstetrics, Neurosurgery, Emergency and Geriatric Departments, and were followed for 30 days. A multivariate analysis was performed to analyze the differences between 30-day survivors and nonsurvivors, and to determine the independent risk factors. Receiver operator characteristic (ROC) curves were also used to determine the predictive power of the model. Among the 285 patients with KP-associated ICUAP, the median age was 70.55 years, and 61.6% were men. Fifty patients died. The nonsurvivors had a lower Glasgow coma score (GCS), platelet count, and albumin concentrations, but higher lactate concentrations, than the survivors. The nonsurvivors were also more likely to be admitted to the ICU for respiratory failure and surgery, and they received less appropriate empirical antimicrobial therapy than the survivors. A lower GCS (odds ratio [OR] = 0.836, 95% confidence interval [CI]: 0.770-0.907), lower albumin concentrations (OR = 0.836, 95% CI: 0.770-0.907), higher lactate concentrations (OR = 1.167, 95% CI: 1.0013-1.344) and inappropriate empirical treatment (OR = 2.559, 95% CI: 1.080-6.065) were independent risk factors for mortality in patients with KP-associated ICUAP. ROC curve analysis showed that the risk of death was higher in patients with 2 or more independent risk factors. The predictive model was effective, with an area under the ROC curve of 0.823 (95% CI: 0.773-0.865). The number of independent risk factors is positively correlated with the risk of death. Our model shows excellent predictive performance.

Clinical characteristics and risk factors for mortality in patients with coronavirus disease 2019 in intensive care unit: a single- center, retrospective, observational study in China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a potentially life-threatening contagious disease which has spread all over the world. Risk factors associated with the clinical outcomes of COVID-19 pneumonia in intensive care unit (ICU) have not yet been well determined. METHODS: This was a retrospective, single-centered, observational study, in which 47 patients with confirmed COVID-19 were consecutively enrolled from February 24 to April 5, 2020. The patients were registered from the ICU of Leishenshan Hospital in Wuhan, China. Clinical characteristics and outcomes were collected and compared between survivors and non-survivors. Multivariable logistic regression was performed to analyze the risk factors of death in patients with COVID-19. RESULTS: The study cohort included 47 adult patients with an average age of 70.55±12.52 years, and 30 (63.8%) patients were men. Totally 15 (31.9%) patients died. When compared to survivors, nonsurvivors showed a higher proportion of septic shock [6 (40%) patients vs. 3 (9.4%) patients], disseminated intravascular coagulation [3 (21.4%) vs. 0], and had higher score of APACHE II (25.07±8.03 vs. 15.56±5.95), CURB-65 {3 [2-4] vs. 2 [1-3]}, Sequential Organ Failure Assessment (SOFA) {7 [5-9] vs. 3 [1-6]}, higher level of D-dimer {5.74 [2.32-18] vs 2.05 [1.09-4.00]} and neutrophil count {9.4 [7.68-14.54] vs. 5.32 [3.85-9.34]}. SOFA score (OR 1.47; 95% CI: 1.01-2.13; P=0.0042) and the lymphocyte count (OR 0.02; 95% CI: 0.00-0.86; P=0.042) on admission were independently risk factors for mortality. Patients with higher lymphocyte count (>0.63×109 /L) and lower SOFA score (≤4) on admission had a significantly better prognosis than those with lower lymphocyte count (≤0.63×109 /L) and higher SOFA score (>4) in overall survival. CONCLUSIONS: Higher SOFA score and lower lymphocyte count at admission were connected with poor prognosis of patients with COVID-19 in ICU. Lymphocyte count may serve as a promising prognostic biomarker.

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

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 ß-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.