Background: Klebsiella pneumoniae bloodstream infection (KP-BSI) is a severe and potentially fatal complication in patients with acute leukemia. The increasing prevalence of carbapenem-resistant (CR) and multidrug-resistant (MDR) strains presents significant therapeutic challenges and may worsen clinical outcomes.

Methods: We retrospectively analyzed 161 adult patients with acute leukemia who developed KP-BSI. Clinical features, antimicrobial susceptibility, treatment regimens, and outcomes were recorded. Multivariate logistic regression was performed to identify risk factors associated with CRKP and MDR-KP BSI, as well as predictors of 30-day mortality.

Results: Among the 161 cases of KP-BSI, 14 (8.7%) were due to CRKP, and 81 (50.3%) were MDR-KP. Prior use of carbapenems was an independent risk factor for CRKP (OR 10.34; 95% CI, 2.90–55.01; P < .001), while prior aminoglycoside use was associated with decreased risk of CRKP (OR 0.042; P < .001) and MDR-KP (OR 0.371; P < .001). Hematopoietic stem cell transplantation (HSCT) was independently associated with MDR-KP infection (OR 6.04; P < .001). The overall 30-day mortality rate was 9.9%, but significantly higher in CRKP cases compared to non-CRKP cases (28.6% vs. 8.2%; P < .001). On multivariate analysis, pulmonary infection (OR 5.88; P = .017) and leukemia disease status (OR 0.246; P = .043) were independent predictors of 30-day mortality.

Conclusion: CRKP and MDR-KP pose serious threats to patients with acute leukemia and KP-BSI. Prior antibiotic exposure and HSCT are significant risk factors. Timely initiation of appropriate empirical therapy is critical for improving survival in this high-risk population.

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2025
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