{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:58:57Z","timestamp":1790744337458,"version":"4.1.0"},"reference-count":41,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100010814","name":"Anhui Provincial Department of Education","doi-asserted-by":"publisher","award":["2024AH050739"],"award-info":[{"award-number":["2024AH050739"]}],"id":[{"id":"10.13039\/501100010814","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010814","name":"Anhui Provincial Department of Education","doi-asserted-by":"publisher","award":["SK2021ZD0032"],"award-info":[{"award-number":["SK2021ZD0032"]}],"id":[{"id":"10.13039\/501100010814","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["mSystems"],"published-print":{"date-parts":[[2025,8,19]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      The prevalence of multidrug-resistant\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      (MDR-KP) is rising globally. The aim of this study was to investigate the epidemiology, risk factors, and clinical outcomes of MDR-KP coinfections with multiple microbes and infections with carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      (CRKP) among patients in a tertiary hospital in China and to establish an individualized linear prediction model. In this retrospective study, patients admitted from January 2021 to March 2024 with a diagnosis of MDR-KP infection were included. We recorded demographics, comorbidities, laboratory indicators, therapeutic interventions, antimicrobial susceptibility tests (ASTs), and analyzed clinical outcomes. Logistic regression models were employed to evaluate the risk factors associated with MDR-KP coinfections and infections with CRKP. A total of 164 patients with MDR-KP infection were included. Of these patients, 78 (47.6%) were infected with MDR-KP only, and 86 (52.4%) were coinfected with other microbes; 115 (70.1%) were infected with extended-spectrum beta-lactamase-producing\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      (ESBL-KP), and 49 (29.9%) were infected with CRKP. The most common source of infection among patients with MDR-KP infection was the respiratory tract (96\/164, 58.5%), followed by the urinary tract (31\/164, 18.9%). Multivariate logistic regression analysis showed that nasogastric catheters (odds ratio [OR], 5.351; 95% confidence inteval [CI], 1.437\u201319.926,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.012), as well as venous and arterial catheters (OR, 5.182; 95% CI, 1.272\u201321.113,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.022), were independent risk factors for coinfection. The total risk score for all factors was 143.3, with a predicted risk rate ranging from 0.25 to 0.85. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for predicting coinfection based on the total risk score was 0.773 (95% CI: 0.7054\u20130.8405). Tracheostomy (OR, 4.673; 95% CI, 1.153\u201318.937,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.031) and fiberoptic bronchoscopy (OR, 4.041; 95% CI, 1.305\u201312.516,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.015) were independent risk factors for infection with CRKP. The total risk score for all factors was 193.9, with a predicted risk rate ranging from 0.15 to 0.85. In the ROC analysis, the AUC for predicting CRKP using the total risk score was 0.752 (95% CI: 0.6739\u20130.8306). Analysis of the calibration curve indicated good agreement between the observed and predicted values. The log-rank test was used to compare all-cause mortality between the two groups, and 30-day mortality was higher in the coinfected group than that in the MDR-KP alone group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.03). There was no significant difference in 30-day mortality between the CRKP and ESBL-KP groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.09). This study successfully established a predictive model based on risk factors, which has good predictive value for both patients with coinfections and those with CRKP. Coinfections and CRKP infections were significantly associated with increased overall mortality, elevated healthcare costs, and poor prognosis in patients. These findings provided a basis for further clinical research and optimization of management strategies for MDR-KP coinfections and CRKP infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      Coinfections and carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      (CRKP) infections significantly increased morbidity and economic burden, leading to longer intensive care unit (ICU) stays and poorer prognoses. Coinfection may also lead to a higher 30-day mortality rate. Patients suffering from multidrug-resistant\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      (MDR-KP) used two or more antibiotics for infection control, but the therapeutic outcomes remained suboptimal. In order to reverse the rising trend in mortality rate associated with coinfection and CRKP infection, certain measures need to be taken: (i) develop stricter protocols for terminal cleaning of rooms (especially ICUs), cleaning of equipment (such as bronchoscopes) and hand hygiene; (ii) conduct antimicrobial resistance gene testing in the healthcare environment and implement antimicrobial stewardship to optimize antibiotic consumption and reduce the emergence and spread of multidrug-resistant organisms.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/msystems.01757-24","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T15:13:58Z","timestamp":1752160438000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":12,"title":["Multidrug-resistant\n                    <i>Klebsiella pneumoniae<\/i>\n                    coinfection with multiple microbes: a retrospective study on its risk factors and clinical outcomes"],"prefix":"10.1128","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8984-0012","authenticated-orcid":false,"given":"Xixi","family":"Song","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0234wv516","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Laboratory, The Affiliated Chaohu Hospital of Anhui Medical University","place":["ChaoHu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1377-6946","authenticated-orcid":false,"given":"Chonghe","family":"Xu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/053qy4437","id-type":"ROR","asserted-by":"publisher"}],"name":"Beijing Friendship Hospital, Capital Medical University","place":["Beijing, China"]},{"id":[{"id":"https:\/\/ror.org\/013xs5b60","id-type":"ROR","asserted-by":"publisher"}],"name":"School of Basic Medical Sciences, Capital Medical 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