Dataset Information

Protective efficacy of statins in patients with Klebsiella pneumoniae bloodstream infection.

ABSTRACT:

Background

Patients with bloodstream infection of Klebsiella pneumoniae (BSI-KP) have a high risk of death and septic shock. This study aims to identify the risk factors for mortality and severity in patients of BSI-KP.

Methods

Data of BSI-KP patients were extracted from the MIMIC IV (Medical Information Mart for Intensive Care IV) database, and patients infected with only K. pneumoniae in blood were included in this study. The risk factors of 28-day mortality and septic shock in BSI-KP patients were analyzed, respectively.

Results

A total of 279 patients enrolled and the all-cause 28-day mortality rate was 11.8%. The use of statins (OR 0.220, 95% CI 0.060-0.801, p = 0.022) and quinolones (OR 0.356, 95% CI 0.143-0.887, p = 0.027) were both independent protective factors for death within 28 days, while the use of vasoactive drugs (OR 7.377, 95% CI 1.775-30.651, p = 0.006) was a risk factor. Besides, pulmonary disease (OR 2.348, 95% CI 1.126-4.897, p = 0.023), bleeding and coagulation disorders (OR 3.626, 95% CI 1.783-7.372, p < 0.001), respiratory failure (OR 2.823, 95% CI 0.178-6.767, p = 0.020) and kidney dysfunction (OR 2.450, 95% CI 1.189-5.047, p = 0.015) were independent risk factors for patients suffered from septic shock while hypertension was a protective one. The receiver operating characteristic (ROC) curves could well predict the risk of death within 28-day (area under ROC = 0.855, 95% CI = 0.796-0.914, p < 0.001) and septic shock (AUROC = 0.815, 95% CI = 0.755-0.874, p < 0.001) in patients with BSI-KP.

Conclusion

The use of statins could decrease the risk of 28-day mortality in patients of BSI-KP. The risk factor-based prediction model provided evidence for drug treatment in BSI-KP patients. Paying more attention to the strategy of drug treatment will be an optimal way to improve patient's outcome in clinical practice.

SUBMITTER: Xu Q

PROVIDER: S-EPMC9849249 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Protective efficacy of statins in patients with <i>Klebsiella pneumoniae</i> bloodstream infection.

Xu Qian Q Zheng Beiwen B Shen Ping P Xiao Yonghong Y

Frontiers in cellular and infection microbiology 20230105

<h4>Background</h4>Patients with bloodstream infection of <i>Klebsiella pneumoniae</i> (BSI-KP) have a high risk of death and septic shock. This study aims to identify the risk factors for mortality and severity in patients of BSI-KP.<h4>Methods</h4>Data of BSI-KP patients were extracted from the MIMIC IV (Medical Information Mart for Intensive Care IV) database, and patients infected with only <i>K. pneumoniae</i> in blood were included in this study. The risk factors of 28-day mortality and se ...[more]

PMID: 36683706

Similar Datasets

Project description:BackgroundKlebsiella pneumoniae bloodstream infection (KP BSI) is a severe clinical condition characterized by high mortality rates. Despite the clinical significance, accurate predictors of mortality in KP BSI have yet to be fully identified.MethodsA retrospective analysis was conducted on the clinical data of 90 cases of KP BSI. The clinical data was extracted from electronic medical records. Antimicrobial susceptibility testing, string testing, and whole-genome sequencing (WGS) were performed on all isolates. Additionally, relevant bioinformatics analyses, such as phylogenetic analysis and assessment of resistance and virulence genes, were carried out. Logistic regression modeling was employed to evaluate the risk factors associated with 28-day mortality in patients with KP BSI, considering both host characteristics and the characteristics of the causative Klebsiella pneumoniae (KP) isolates.ResultsAmong the 90 patients included in this study, the 28-day mortality rate for those with KP BSI was 30.00% (27/90). Multivariate analysis revealed several host-related factors associated with an increased risk of 28-day mortality. These factors included an elevated qSOFA score (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.21-7.31, p = 0.017), presence of septic shock (OR 8.21, 95% CI 1.63-41.93, p = 0.008), and nosocomial infection (OR 7.72, 95% CI 1.71-34.74, p = 0.002). Regarding bacterial factors, the presence of the virulence genes rfbA/B/D (OR 8.53, 95% CI 1.41-51.57, p = 0.020) was identified as an independent risk factor, particularly for nosocomial infection patients. However, hypermucoviscosity phenotype, ST type, serotype, and resistance genes were not associated with an increased risk of 28-day mortality.ConclusionThe carriage of virulence genes rfbA/B/D, which is responsible for the synthesis of O-antigen, was associated with poor prognosis of KP BSI. It may facilitate the clinical management of patients with bloodstream infection (BSI) caused by hypervirulent KP strains, especially those with rfbA/B/D genes.Clinical trial numberNot applicable.

Project description:BackgroundPresence of capsule enhances the virulence of bacteria that cause pneumonia, meningitis, cystic fibrosis, dental caries, periodontitis. Capsule is an important virulence factor for Klebsiella pneumoniae and infections due to this pathogen have been associated with high mortality rates. In the present study, use of an Aeromonas punctata derived capsule depolymerase against K. pneumoniae, to reinstate the efficacy of gentamicin during pneumonia and septicemia was investigated.MethodsDepolymerase was administered in mice intraperitoneally (50 μg) alone as well in combination with gentamicin (1.5 mg/kg), 24 h post infection during acute lung infection and 6 h later during septicemia. Bacterial load, neutrophil infiltration and cytokine levels were estimated. The immunogenicity of protein was also studied.ResultsIn comparison to groups treated with gentamicin alone, combination treatment with depolymerase and gentamicin significantly reduced (P < 0.01) bacterial titer in the lungs, liver, kidney, spleen and blood of experimental animals. Highly significant reduction in neutrophil infiltration and levels of pro-inflammatory and anti-inflammatory cytokines was also observed. This indicated an efficient capsule removal by the enzyme, that improved gentamicin efficacy in vivo. Although the enzyme was found to be immunogenic, but no significant reduction in treatment efficacy was observed in the preimmunized as well as naïve mice. In addition, as confirmed through flow cytometry, the hyperimmune sera raised against the enzyme did not neutralize its activity.ConclusionThe results confirm that administration of enzyme 'depolymerase' along with gentamicin not only checked the virulence of K. pneumoniae in vivo but it also increased its susceptibility to gentamicin at a lower concentration. Such a strategy would help to avoid exposure to higher concentration of gentamicin. Moreover, since this decapsulating protein does not possess a lytic activity therefore there would be no chances of development of bacterial resistance against it. Therefore, it should be studied further for its successful inclusion in our prophylactic/therapeutic regimes.