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Background <p><i>Klebsiella</i> spp. causing bloodstream infections (BSIs) with resistance to carbapenems and/or colistin are associated with high mortality and limited treatment options. While procalcitonin (PCT) kinetics have prognostic value in other settings, their role in resistant <i>Klebsiella </i>spp. infections remains unclear. This study aimed to evaluate the predictors of 14 day mortality and the prognostic value of early PCT kinetics in this high risk population.</p> Methods <p>We conducted a retrospective study at a tertiary care center, including adult intensive care unit (ICU) patients with monomicrobial BSIs due to carbapenem and/or colistin-resistant <i>Klebsiella</i> spp. demographic and clinical data, severity scores, antimicrobial regimens, and PCT values at baseline and 72 h were recorded. Analyses were performed separately for the carbapenem-resistant and colistin-resistant cohorts. An early PCT response was defined as a ≥50% decline at 72 h. Logistic regression analysis was used to identify factors associated with 14 day mortality.</p> Results <p>A total of 211 carbapenem-resistant <i>Klebsiella</i> spp. BSIs episodes and 104 colistin-resistant episodes were analyzed as two partially overlapping cohorts. Among the carbapenem-resistant isolates, 97 were also resistant to colistin, while seven colistin-resistant isolates were carbapenem susceptible. The overall 14 day mortality rate was 49.3%. In the carbapenem-resistant group, malignancy, Pitt bacteremia score ≥4, and lactate ≥2 mmol/L were independently associated with mortality. In contrast, appropriate pathogen directed therapy and early PCT response were protective factors in both cohorts. In the colistin-resistant group, definitive therapy with ceftazidime–avibactam was associated with the lowest mortality, while regimens including tigecycline or fosfomycin were associated with better outcomes than fully inactive therapy.</p> Conclusions <p>Mortality in carbapenem and colistin-resistant <i>Klebsiella</i> BSIs remains high and is primarily driven by illness severity. Early PCT decline and appropriate definitive therapy were independently associated with improved survival. Monitoring PCT kinetics may provide timely prognostic guidance and support early treatment optimization, particularly in settings with limited access to newer antimicrobial agents.</p> Clinical trial number <p>Not applicable.</p>

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Early procalcitonin kinetics as an independent predictor of mortality in multi-drug resistant Klebsiella spp. bloodstream infections: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月18日

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  • Nesibe Korkmaz,
  • Gönül Çiçek Şentürk,
  • Feray Aycan Yılmaz,
  • Gülnur Kul,
  • Bedirhan Güldoğan,
  • Hatice Merve Yılmaz,
  • Fatma Zehra Şahin,
  • Hicret Ertekin,
  • Aslı Haykır Solay,
  • Semanur Kuzi,
  • Dilek Bulut,
  • Emin Ediz Tütüncü

摘要

Background

Klebsiella spp. causing bloodstream infections (BSIs) with resistance to carbapenems and/or colistin are associated with high mortality and limited treatment options. While procalcitonin (PCT) kinetics have prognostic value in other settings, their role in resistant Klebsiella spp. infections remains unclear. This study aimed to evaluate the predictors of 14 day mortality and the prognostic value of early PCT kinetics in this high risk population.

Methods

We conducted a retrospective study at a tertiary care center, including adult intensive care unit (ICU) patients with monomicrobial BSIs due to carbapenem and/or colistin-resistant Klebsiella spp. demographic and clinical data, severity scores, antimicrobial regimens, and PCT values at baseline and 72 h were recorded. Analyses were performed separately for the carbapenem-resistant and colistin-resistant cohorts. An early PCT response was defined as a ≥50% decline at 72 h. Logistic regression analysis was used to identify factors associated with 14 day mortality.

Results

A total of 211 carbapenem-resistant Klebsiella spp. BSIs episodes and 104 colistin-resistant episodes were analyzed as two partially overlapping cohorts. Among the carbapenem-resistant isolates, 97 were also resistant to colistin, while seven colistin-resistant isolates were carbapenem susceptible. The overall 14 day mortality rate was 49.3%. In the carbapenem-resistant group, malignancy, Pitt bacteremia score ≥4, and lactate ≥2 mmol/L were independently associated with mortality. In contrast, appropriate pathogen directed therapy and early PCT response were protective factors in both cohorts. In the colistin-resistant group, definitive therapy with ceftazidime–avibactam was associated with the lowest mortality, while regimens including tigecycline or fosfomycin were associated with better outcomes than fully inactive therapy.

Conclusions

Mortality in carbapenem and colistin-resistant Klebsiella BSIs remains high and is primarily driven by illness severity. Early PCT decline and appropriate definitive therapy were independently associated with improved survival. Monitoring PCT kinetics may provide timely prognostic guidance and support early treatment optimization, particularly in settings with limited access to newer antimicrobial agents.

Clinical trial number

Not applicable.