Study on the diagnostic value of inflammatory markers, clinical characteristics in patients with different prognoses, and antimicrobial susceptibility analysis for Klebsiella pneumoniae bloodstream infection
10.3760/cma.j.cn112309-20241015-00349
- VernacularTitle:肺炎克雷伯菌血流感染炎症指标诊断价值、不同预后临床特征及药敏分析研究
- Author:
Meixiu PAN
1
;
Xiujian MENG
;
Weijian LIN
;
Yingying MAI
;
Debin MAO
Author Information
1. 梧州市红十字会医院医学检验科，梧州 543002
- Publication Type:Journal Article
- Keywords:
Klebsiella pneumoniae;
C-reactive protein;
Procalcitonin;
Empirical treatment;
Fluoroquinolone;
Drug susceptibility testing;
Bloodstream infection
- From:
Chinese Journal of Microbiology and Immunology
2025;45(8):649-656
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the diagnostic value of inflammatory markers, clinical characteristics of patients with different prognoses, and variations in antimicrobial susceptibility testing for Klebsiella pneumoniae bloodstream infection. Methods:This study involved 166 patients with positive blood cultures for Klebsiella pneumoniae from January 2018 to May 2023 as the Klebsiella pneumoniae-positive group, and 100 patients with negative blood culture results as the negative group. The diagnostic value of inflammatory markers for Klebsiella pneumoniae bloodstream infection was evaluated through receiver operating characteristic (ROC) curve. The differences in C-reactive protein (CRP) and procalcitonin (PCT) levels between Klebsiella pneumoniae bloodstream infections and non- Klebsiella pneumoniae bloodstream infections were analyzed. According to the prognoses, 166 patients with Klebsiella pneumoniae bloodstream infection were divided into two groups: favorable outcome group (105 cases) and adverse outcome group (61 cases). Clinical features, infection sites, empirical use of antibiotics, and antimicrobial susceptibility were compared between the patients with different outcomes. Results:The percentage of neutrophils ( Z=-3.645, P<0.001), CRP level ( Z=-6.809, P<0.001), and PCT level ( Z=-8.214, P<0.001) were significantly higher in the Klebsiella pneumoniae-positive group than in the negative group. The area under the ROC curve (AUC) values for CRP and PCT in diagnosing Klebsiella pneumoniae bloodstream infection were 0.755 and 0.849, respectively. There were variations in CRP ( H=20.902, P<0.001) and PCT ( H=33.521, P<0.001) levels among patients with bloodstream infection caused by Klebsiella pneumoniae, other common negative bacilli, common positive cocci, or Candida. The body temperature, albumin level, hemoglobin level, and length of hospital stay in the adverse outcome group were lower than those in the favorable outcome group ( P<0.05). Besides, the incidence of invasive operation, organ failure, shock, and rescue were also lower in the adverse outcome group ( P<0.05). In the adverse outcome group, co-infections mainly involved respiratory infections, accounting for 60.7% (37/61). Respiratory infections (49.5%, 52/105) were also the predominant co-infections in the favorable outcome group, followed by hepatobiliary infections (34.3%, 36/105). The pathogenic bacteria cultured from different infection sites were mainly Klebsiella pneumoniae. In the favorable outcome group, fluoroquinolones were the most commonly used medications for empirical therapy, with a usage rate of 76.2% (80/105), followed by β-lactamase inhibitor complex preparations (68.6%, 72/105), the usage rate of which were significantly higher than those in the adverse outcome group ( P<0.05). Carbapenems were the preferred drugs for the adverse outcome group, with a usage rate of up to 62.3% (38/61), which was significantly higher than that in the favorable outcome group ( P<0.05). The adverse outcome group showed high resistance rates to ciprofloxacin (40.98%, 25/61) and levofloxacin (37.7%, 23/61), while the resistance rates were 22.86% (24/105) and 32.38% (34/105) in the favorable outcome group. The resistance rates to other drugs were low and there was no significant difference between the two groups ( P>0.05). Conclusions:PCT and CRP have certain value in diagnosing bloodstream infections caused by Klebsiella pneumoniae, and have certain reference significance for differentiating bloodstream infections caused by Gram-negative bacteria, Gram-positive bacteria, and Candida species. The source of bloodstream infection in patients with adverse outcome may be the respiratory system, while in patients with favorable outcome, the main sources of bloodstream infection may be the respiratory and hepatobiliary systems. Antimicrobial susceptibility testing reveals the highest resistance rate to fluoroquinolones. Given their frequent use in empirical therapy, this may lead to treatment failure. Notably, carbapenems are more commonly administered as empirical antibiotics in the adverse outcome group.
