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Antimicrobial resistance and risk factors for mortality of pneumonia caused by Klebsiella pneumoniae among diabetics: a retrospective study conducted in Shanghai, China.
Infect Drug Resist. 2019; 12:1089-1098.ID

Abstract

Purpose:

To investigate antimicrobial resistance and risk factors for mortality of Klebsiella pneumoniae (KP) pneumonia in diabetics and nondiabetics. Patients and methods: A retrospective study was conducted among inpatients of KP pneumonia via electronic medical records in a territory hospital between January 2016 and June 2018. Antimicrobial resistance in KP pneumonia was compared between diabetics and nondiabetics. Independent risk factors for mortality in KP pneumonia were identified by univariate and multivariate logistic regression among diabetics and nondiabetics separately.

Results:

In this study, 456 patients with KP pneumonia were included. There were 156 cases with diabetes and 300 without diabetes. KP showed a lower antimicrobial resistance to a multitude of antimicrobials in pneumonia among diabetics than nondiabetics, namely aztreonam, cefotetan, sulperazone, meropenem, amikacin, tobramycin, sulfamethoxazole, and fosfomycin. In addition, carbapenem-resistant Klebsiella pneumoniae (CRKP) was more prevalent among nondiabetics than diabetics who were admitted to intensive care unit (ICU) (63.0% vs 45.1%, P = 0.038). Multivariable analysis showed that independent risk factors for in-hospital mortality (IHM) in KP pneumonia among diabetics differed from that among nondiabetics as well. Independent predictors for IHM of KP pneumonia among diabetics were male (OR: 5.89, 95% CI: 1.34-25.93, P = 0.019), albumin (ALB) < 35 g/L (OR: 7.00, 95% CI: 2.02-24.28, P = 0.002), bloodstream infection (BSI) (OR: 21.14, 95% CI: 3.18-140.72, P = 0.002), and invasive ventilation during hospitalization (OR: 8.00, 95% CI: 2.99-21.42, P < 0.001). In nondiabetics, independent predictors were higher CURB-65 score (OR: 1.92, 95% CI: 1.29-2.86, P = 0.001), CRKP (OR: 2.72, 95% CI: 1.07-6.90, P = 0.035), BSI (OR: 4.98, 95% CI: 1.34-18.50, P = 0.017), and ICU admission (OR: 4.06, 95% CI: 1.57-10.47, P = 0.004).

Conclusion:

In KP pneumonia, diabetics showed lower antimicrobial resistance and different independent risk factors for mortality compared with nondiabetics, in line with previous studies. Importantly, further attention should be paid on rational and effective antibiotic and supportive treatments in order to reduce mortality without aggravating antimicrobial resistance and metabolic damage among diabetics.

Authors+Show Affiliations

Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China. Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China. Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China. Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China. Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31123410

Citation

Liu, Bing, et al. "Antimicrobial Resistance and Risk Factors for Mortality of Pneumonia Caused By Klebsiella Pneumoniae Among Diabetics: a Retrospective Study Conducted in Shanghai, China." Infection and Drug Resistance, vol. 12, 2019, pp. 1089-1098.
Liu B, Yi H, Fang J, et al. Antimicrobial resistance and risk factors for mortality of pneumonia caused by Klebsiella pneumoniae among diabetics: a retrospective study conducted in Shanghai, China. Infect Drug Resist. 2019;12:1089-1098.
Liu, B., Yi, H., Fang, J., Han, L., Zhou, M., & Guo, Y. (2019). Antimicrobial resistance and risk factors for mortality of pneumonia caused by Klebsiella pneumoniae among diabetics: a retrospective study conducted in Shanghai, China. Infection and Drug Resistance, 12, 1089-1098. https://doi.org/10.2147/IDR.S199642
Liu B, et al. Antimicrobial Resistance and Risk Factors for Mortality of Pneumonia Caused By Klebsiella Pneumoniae Among Diabetics: a Retrospective Study Conducted in Shanghai, China. Infect Drug Resist. 2019;12:1089-1098. PubMed PMID: 31123410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antimicrobial resistance and risk factors for mortality of pneumonia caused by Klebsiella pneumoniae among diabetics: a retrospective study conducted in Shanghai, China. AU - Liu,Bing, AU - Yi,Huahua, AU - Fang,Jie, AU - Han,Lizhong, AU - Zhou,Min, AU - Guo,Yi, Y1 - 2019/05/07/ PY - 2019/01/04/received PY - 2019/03/23/accepted PY - 2019/5/25/entrez PY - 2019/5/28/pubmed PY - 2019/5/28/medline KW - Klebsiella pneumoniae KW - antimicrobial resistance KW - diabetics KW - mortality KW - pneumonia KW - risk factor SP - 1089 EP - 1098 JF - Infection and drug resistance JO - Infect Drug Resist VL - 12 N2 - Purpose: To investigate antimicrobial resistance and risk factors for mortality of Klebsiella pneumoniae (KP) pneumonia in diabetics and nondiabetics. Patients and methods: A retrospective study was conducted among inpatients of KP pneumonia via electronic medical records in a territory hospital between January 2016 and June 2018. Antimicrobial resistance in KP pneumonia was compared between diabetics and nondiabetics. Independent risk factors for mortality in KP pneumonia were identified by univariate and multivariate logistic regression among diabetics and nondiabetics separately. Results: In this study, 456 patients with KP pneumonia were included. There were 156 cases with diabetes and 300 without diabetes. KP showed a lower antimicrobial resistance to a multitude of antimicrobials in pneumonia among diabetics than nondiabetics, namely aztreonam, cefotetan, sulperazone, meropenem, amikacin, tobramycin, sulfamethoxazole, and fosfomycin. In addition, carbapenem-resistant Klebsiella pneumoniae (CRKP) was more prevalent among nondiabetics than diabetics who were admitted to intensive care unit (ICU) (63.0% vs 45.1%, P = 0.038). Multivariable analysis showed that independent risk factors for in-hospital mortality (IHM) in KP pneumonia among diabetics differed from that among nondiabetics as well. Independent predictors for IHM of KP pneumonia among diabetics were male (OR: 5.89, 95% CI: 1.34-25.93, P = 0.019), albumin (ALB) < 35 g/L (OR: 7.00, 95% CI: 2.02-24.28, P = 0.002), bloodstream infection (BSI) (OR: 21.14, 95% CI: 3.18-140.72, P = 0.002), and invasive ventilation during hospitalization (OR: 8.00, 95% CI: 2.99-21.42, P < 0.001). In nondiabetics, independent predictors were higher CURB-65 score (OR: 1.92, 95% CI: 1.29-2.86, P = 0.001), CRKP (OR: 2.72, 95% CI: 1.07-6.90, P = 0.035), BSI (OR: 4.98, 95% CI: 1.34-18.50, P = 0.017), and ICU admission (OR: 4.06, 95% CI: 1.57-10.47, P = 0.004). Conclusion: In KP pneumonia, diabetics showed lower antimicrobial resistance and different independent risk factors for mortality compared with nondiabetics, in line with previous studies. Importantly, further attention should be paid on rational and effective antibiotic and supportive treatments in order to reduce mortality without aggravating antimicrobial resistance and metabolic damage among diabetics. SN - 1178-6973 UR - https://www.unboundmedicine.com/medline/citation/31123410/Antimicrobial_resistance_and_risk_factors_for_mortality_of_pneumonia_caused_by_Klebsiella_pneumoniae_among_diabetics:_a_retrospective_study_conducted_in_Shanghai,_China L2 - https://dx.doi.org/10.2147/IDR.S199642 DB - PRIME DP - Unbound Medicine ER -
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