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Background <p>Sepsis caused by carbapenemase-producing Enterobacterales, particularly Klebsiella pneumoniae carbapenemase (KPC)-producing strains, is associated with high mortality and limited treatment options. However, data regarding dynamic organ dysfunction and prognostic factors in this population remain limited.</p> Objective <p>To compare the clinical characteristics and outcomes of sepsis due to KPC-producing versus non-KPC-producing Enterobacterales and to identify independent predictors of 28-day mortality.</p> Methods <p>In this single-center retrospective cohort study, 320 intensive care unit (ICU) patients with sepsis and microbiologically confirmed Enterobacterales infection (January-December 2024) were included. Patients were classified as KPC (<i>n</i> = 210) or non-KPC (<i>n</i> = 110) using the NG-Test CARBA 5 assay, with polymerase chain reaction (PCR) confirmation when available. The primary outcome was 28-day all-cause mortality from sepsis onset. Multivariable logistic and Cox regression analyses were performed.</p> Results <p>The KPC group had significantly higher 28-day mortality than the non-KPC group (35.2% vs. 23.6%, odds ratio [OR] = 1.77, 95% confidence interval [CI]: 1.04-3.00, <i>P</i> = 0.030). KPC infection remained independently associated with mortality after adjustment (adjusted OR [aOR] = 1.58, 95% CI: 1.02–2.44, <i>P</i> = 0.04). Additional independent risk factors included higher Day-1 Sequential Organ Failure Assessment (SOFA) score (aOR = 1.08), elevated lactate level (aOR = 1.12), and inadequate early antimicrobial therapy (aOR = 1.69; all <i>P</i> &lt; 0.05). In the KPC subgroup, ΔSOFA, positive fluid balance, and low albumin levels were also associated with mortality.</p> Conclusion <p>Sepsis caused by KPC-producing Enterobacterales is associated with more severe organ dysfunction and increased short-term mortality. Early administration of appropriate antimicrobial therapy, along with optimized organ support and fluid management, may improve clinical outcomes.</p> Clinical trial number <p>Not applicable.</p>

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Clinical characteristics and 28-day outcomes of sepsis associated with klebsiella pneumoniae carbapenemase-producing Enterobacterales: a single-center retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月8日

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  • Sheng Huang,
  • Sun Yu,
  • Bin Pan,
  • Xiaoping Yang,
  • Jun Sha,
  • Yilan Wang,
  • Chunyang Xu

摘要

Background

Sepsis caused by carbapenemase-producing Enterobacterales, particularly Klebsiella pneumoniae carbapenemase (KPC)-producing strains, is associated with high mortality and limited treatment options. However, data regarding dynamic organ dysfunction and prognostic factors in this population remain limited.

Objective

To compare the clinical characteristics and outcomes of sepsis due to KPC-producing versus non-KPC-producing Enterobacterales and to identify independent predictors of 28-day mortality.

Methods

In this single-center retrospective cohort study, 320 intensive care unit (ICU) patients with sepsis and microbiologically confirmed Enterobacterales infection (January-December 2024) were included. Patients were classified as KPC (n = 210) or non-KPC (n = 110) using the NG-Test CARBA 5 assay, with polymerase chain reaction (PCR) confirmation when available. The primary outcome was 28-day all-cause mortality from sepsis onset. Multivariable logistic and Cox regression analyses were performed.

Results

The KPC group had significantly higher 28-day mortality than the non-KPC group (35.2% vs. 23.6%, odds ratio [OR] = 1.77, 95% confidence interval [CI]: 1.04-3.00, P = 0.030). KPC infection remained independently associated with mortality after adjustment (adjusted OR [aOR] = 1.58, 95% CI: 1.02–2.44, P = 0.04). Additional independent risk factors included higher Day-1 Sequential Organ Failure Assessment (SOFA) score (aOR = 1.08), elevated lactate level (aOR = 1.12), and inadequate early antimicrobial therapy (aOR = 1.69; all P < 0.05). In the KPC subgroup, ΔSOFA, positive fluid balance, and low albumin levels were also associated with mortality.

Conclusion

Sepsis caused by KPC-producing Enterobacterales is associated with more severe organ dysfunction and increased short-term mortality. Early administration of appropriate antimicrobial therapy, along with optimized organ support and fluid management, may improve clinical outcomes.

Clinical trial number

Not applicable.