TỶ LỆ NHIỄM KLEBSIELLA PNEUMONIAE KHÁNG CARBAPENEM VÀ CÁC YẾU TỐ NGUY CƠ TỬ VONG Ở BỆNH NHÂN ĐỢT CẤP BỆNH PHỔI TẮC NGHẼN MẠN TÍNH

Abstract

Objective: To determine the prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and the risk factors for mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Materials and Methods: A cross-sectional study with longitudinal follow-up was conducted on 132 patients aged ≥18 years who were admitted for acute exacerbation of COPD to the Department of Respiratory Medicine and the Intensive Care Unit between September 2024 and February 2025 in Nguyen Tri Phuong hospital. Risk factors for mortality were analyzed using univariate and multivariate Cox regression. Kaplan–Meier survival analysis was applied to compare mortality between the CRKP and non-CRKP groups. Results: A total of 132 patients were enrolled, with a mean age of 68.8 ± 10.4 years; 88% were male and 94% were smokers. The majority belonged to GOLD group E (73%). The prevalence of K. pneumoniae infection was 23% (30/132), of which CRKP accounted for 19.7% (26/132). Kaplan–Meier analysis demonstrated significantly higher 30-day mortality in the CRKP group compared with the non-CRKP group (log-rank test, p < 0.0001). Multivariate Cox regression identified two independent risk factors for mortality: higher Charlson Comorbidity Index (adjusted HR 1.38; 95% CI 1.13–1.69; p = 0.002) and CRKP infection (adjusted HR 2.67; 95% CI 1.02–7.04; p = 0.046). Conclusion: Carbapenem-resistant K. pneumoniae infection is an independent risk factor for mortality in patients with acute exacerbation of COPD, in addition to comorbidity burden. Early detection and strict control of CRKP are crucial to improve outcomes in this high-risk population.