Acute Exacerbation of Chronic Obstructive Pulmonary Disease Due to Carbapenem-Resistant Klebsiella pneumoniae-Induced Pneumonia: Clinical Features and Prognostic Factors

Pengwen Ouyang,1 Zhijie Zhou,2 Chanyuan Pan,3 Peijuan Tang,1 Sheng Long,1 Xiangjian Liao,1 Qiong Liu,1 Liangyi Xie1 1Department of Clinical Laboratory, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, People’s Republic of China; 2Department of Respiratory Medicine, The Affiliated Zhuzhou Hospital of Xiangya School of Medicine, Central South University, Zhuzhou, People’s Republic of China; 3Department of Respiratory Medicine, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, People’s Republic of ChinaCorrespondence: Liangyi Xie, Email lyxie78@hunnu.edu.cnPurpose: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is closely related to respiratory tract infection. The aim of this study was to investigate the clinical features and prognostic factors of CRKP-induced pneumonia in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.Methods: A single-centre, retrospective case-control study on COPD patients hospitalized for acute exacerbation and CRKP-induced pneumonia was conducted from January 1, 2016, to December 31, 2022. The mortality rate of acute exacerbation due to CRKP-induced pneumonia was investigated. The patients were divided into the CRKP-induced pneumonic acute exacerbation (CRKPpAE) group and the non-CRKP-induced pneumonic acute exacerbation (non-CRKPpAE) group, and the clinical characteristics and prognostic factors were compared using univariate analysis and multivariate analysis.Results: A total of 65 AECOPD patients were included, composed of 26 patients with CRKPpAE and 39 patients with non-CRKPpAE. The mortality rate of CRKPpAE was 57.69%, while non-CRKPpAE was 7.69%. Compared with non-CRKPpAE, a history of acute exacerbation in the last year (OR=8.860, 95% CI: 1.360– 57.722, p=0.023), ICU admission (OR=11.736, 95% CI: 2.112– 65.207, p=0.005), higher NLR levels (OR=1.187, 95% CI: 1.037– 1.359, p=0.013) and higher D-dimer levels (OR=1.385, 95% CI: 1.006– 1.905, p=0.046) were independently related with CRKPpAE. CRKP isolates were all MDR strains (26/26, 100%), and MDR strains were also observed in non-CRKP isolates (5/39, 12.82%).Conclusion: Compared with non-CRKPpAE, CRKPpAE affects the COPD patient’s condition more seriously and significantly increases the risk of death.Keywords: chronic obstructive pulmonary disease, acute exacerbation, carbapenem-resistant K. pneumoniae, pneumonia