ObjectiveTo analyze the epidemiological distribution, microbiological characteristics, drug-resistance status, and risk factors for mortality in adult intensive care unit (ICU) patients with Klebsiella pneumoniae infection.MethodsThis multi-center prospective cohort study included ICU patients with suspected infection from 67 hospitals across 16 Chinese provinces/municipalities between July 1, 2021 and December 31, 2022. Clinical data and microbiological results were collected, and patients were divided into survival and non-survival groups according to their survival status and drug-resistance situation. Risk factors for mortality and drug resistance in ICU patients with Klebsiella pneumonia infection were determined through univariate and multivariate logistic regression analyses.ResultsA total of 2964 ICU-infected patients were enrolled, with 12 175 microbial specimens submitted for testing. Among these, 487 specimens tested positive for Klebsiella pneumoniae. Ultimately, 314 patients with Klebsiella pneumoniae infection were identified, primarily from lung infections, with a drug-resistance rate of 78.3%. The in-hospital mortality rate of ICU patients infected with Klebsiella pneumoniae was 19.8%. Univariate and multivariate logistic regression analyses revealed that older age (P=0.027), high drug-resistance rate (P=0.028), and low clinical-effectiveness rate (P<0.001) were independent risk factors for mortality in ICU patients infected with Klebsiella pneumoniae. Drug-resistance analysis showed that, compared with non-resistant cases, ICU patients with drug-resistant Klebsiella pneumoniae infection had lower pathogen-clearance rates (P=0.003), clinical-effectiveness rates (P=0.004), and antibiotic-effectiveness rates (P<0.010), and higher mortality rates (P=0.006). Patients with Klebsiella pneumoniae abdominal infection (P=0.003) and urinary tract infection (P=0.007) had higher drug-resistance incidences. There were no statistically significant differences in clinical-effectiveness rate, Klebsiella pneumoniae clearance, drug-resistance incidence, mortality rate, or hospital-stay length between patients with lung infection and those with non-lung infection of Klebsiella pneumoniae (P>0.05). Compared with patients with non-bloodstream infection, patients with bloodstream infection of Klebsiella pneumoniae had lower clinical-effectiveness rates (P=0.027) and higher mortality rates (P=0.021).ConclusionsOlder age, high drug-resistance rate, and low clinical-effectiveness rate are independent risk factors for mortality in ICU patients infected with Klebsiella pneumoniae. ICU patients with bloodstream infection of Klebsiella pneumoniae may have lower clinical-effectiveness rates and higher mortality rates. ICU patients with abdominal and urinary tract infections caused by Klebsiella pneumoniae are more likely to develop drug resistance.

intensive care unit;infection;Klebsiella pneumoniae