Klebsiella pneumoniae is one of the leading causes of
nosocomial infections. It has been estimated that
nosocomial infection by Klebsiella pneumoniae comprises 3-8% of all
nosocomial infections. Klebsiella pneumoniae
bloodstream infections (BSIs) occur worldwide with varying mortality. Resistant strains, like those producing extended-spectrum
beta-lactamases (ESBL) and carbapenemases, are becoming increasingly common, especially in hospital settings, posing therapeutic challenges. In this article, we aimed to study the epidemiology and risk factors of BSIs due to resistant Klebsiella pneumoniae strains in the period 1 January 2014-31 December 2018 at the Nicosia General Hospital, the largest tertiary hospital in Cyprus. Data on demographics, co-morbidities, prior hospitalization, prior intensive care unit (ICU) admission, previous antimicrobial use, nosocomial acquisition of the
infection, the presence of a prosthetic device or surgery, and the primary site of
infection were retrospectively recorded. Associations between the detection of ESBL Klebsiella pneumoniae BSIs and factors/covariates were examined using logistic regression. This study involved 175 patients with BSI caused by Klebsiella pneumoniae. Of these, 61 BSIs were caused by ESBL strains, 101 by non-ESBL, and 13 by
carbapenem-resistant (CR) strains. In univariable analyses, age, sex,
heart disease, antimicrobial use during current admission, previous hospitalization (ward or ICU), and primary BSI were associated with the presence of an ESBL strain.
Antibiotic use during current admission and
heart disease remained statistically significantly associated with ESBL Klebsiella pneumoniae BSI in multivariable models.
Antibiotic use during current admission, respiratory
infection, and a recent history of surgery were more prevalent among CR Klebsiella pneumoniae BSI patients than among non-CR Klebsiella pneumoniae BSI patients. Our study showed that recent antimicrobial use and
heart disease were associated with BSI due to ESBL-producing Klebsiella pneumoniae. This finding could inform clinical practice in hospital settings.