Insights into multidrug‑resistant <i>K. pneumoniae</i> urinary tract infections: From susceptibility to mortality

Abstract

The incidence of urinary tract infections (UTIs) caused by <em>Klebsiella pneumoniae</em> has exhibited an increasing trend and has become a high burden for many public health systems, especially in hospital settings. Multidrug resistance associated with the production of extended‑spectrum β‑lactamases (ESBL) among <em>K. pneumoniae</em> isolates is endemic in Southeastern Europe. We retrospectively analyzed 75 cases admitted to ‘St. Parascheva’ Clinical Hospital of Infectious Diseases in Iasi, Romania, during the first 6 months of 2019 (January 1 to June 30), who had a confirmed diagnosis of <em>K. pneumoniae</em> UTI at discharge. From a total of 75 patients, 34 (45.3%) presented ESBL⁺ <em>K. pneumoniae</em>. The mean age was 66 years (70.1 for the ESBL⁺ patients vs. 62.6 for the ESBL^‑ patients, P=0.0365). There was a symmetrical sex distribution (37 men vs. 38 women). Of these, 22 men had ESBL⁺ <em>K. pneumoniae</em> UTIs, compared to only 15 with an ESBL^‑ strain, P=0.0087. Another risk factor for ESBL⁺ <em>K. pneumoniae</em> UTIs was the presence of hospitalization in the past 6 months; 20 (58.82%) patients with ESBL⁺ infections were previously hospitalized, compared to only 5 (12.19%) patients with ESBL^‑ strains, P&lt;0.0001. The urinary catheter carriers presented an increased prevalence of ESBL⁺ infections (15/34 vs. 5/41, P=0.0012). Regarding mortality, ESBL⁺ infections caused 6 fatalities, compared to only 1 death in the ESBL^‑ group, P=0.0166. ESBL⁺ <em>K. pneumoniae</em> strains represent an important cause of healthcare‑related UTIs, with a significantly higher mortality rate compared to ESBL^‑ strains. Early identification and adequate management of the risk factors incriminated in ESBL⁺ UTIs should be a priority for physicians in order to limit the dissemination of the ESBL‑producing strains and thus to improve the outcome of these patients.

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