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Yan-Feng Liu,1,2 Ya Liu,1 Xuefeng Chen,3 Yan Jia1 1Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan, Peopleâs Republic of China; 2National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, Peopleâs Republic of China; 3Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, Peopleâs Republic of ChinaCorrespondence: Yan Jia, Department of Hematology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, Peopleâs Republic of China, Tel/Fax +86-731-89753730, Email jiayan1992@outlook.comObjective: Infection is the most common complication and cause of death after hematopoietic stem cell transplantation (HSCT). Our study aims to investigate the clinical characteristics and risk factors for death of Klebsiella pneumoniae infections in HSCT recipients, so as to provide evidence for guiding antibiotic use and improving prognosis in the future.Methods: The epidemiology, clinical manifestations and drug resistance rate with K. pneumoniae infections among HSCT recipients between January 1, 2012 and September 30, 2021 were retrospectively reviewed. Logistic regression model and Cox regression model were respectively used to determine the risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) acquisition and death.Results: Fifty-nine HSCT recipients suffered from K. pneumoniae infections, with a mortality rate of 42.4%. The most common site was lung, followed by blood stream. The resistance rate of K. pneumoniae to various clinically common antibiotics was high, especially CRKP, which was only sensitive to amikacin and tigecycline. Independent risk factor for CPKP acquisition was a previous infection within 3 months before transplantation (OR=10.981, 95% CI 1.474â 81.809, P=0.019). Independent risk factors for mortality included interval from diagnosis to transplantation > 180 days (HR=3.963, 95% CI 1.25â 12.561, P=0.019), engraftment period > 20 days (HR=8.015, 95% CI 2.355â 27.279, P=0.001), non-use of anti-CMV immunoglobulin/rituximab after transplantation (HR=10.720, 95% CI 2.390â 48.089, P=0.002), and PCT > 5 μg/L (HR=5.906, 95% CI 1.623â 21.500, P=0.007).Conclusion: K. pneumoniae infection has become a serious threat for HSCT recipients, which reminds us to pay enough attention and actively seek new strategies.Keywords: Klebsiella pneumoniae, carbapenems, drug resistance, hematopoietic stem cell transplantation, mortality, risk factors |
