{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T03:28:34Z","timestamp":1773890914438,"version":"3.50.1"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,17]],"date-time":"2021-04-17T00:00:00Z","timestamp":1618617600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,17]],"date-time":"2021-04-17T00:00:00Z","timestamp":1618617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Over the past decades,\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      (\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ) infections have been increasing and affected immunocompromised patients nosocomially and communally, with extended-spectrum \u03b2-lactamase (ESBL) production becoming a major concern. Patients with rheumatic autoimmune diseases, mostly receiving immunosuppressive therapy, are vulnerable to various infections, including\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      . However, few have investigated\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      infections in this specific population. This study aimed to identify factors associated with ESBL production and mortality of\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      pneumonia among patients with rheumatic autoimmune diseases in the Emergency Department.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively investigated patients with rheumatic diseases who were diagnosed with\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      pneumonia. The diagnosis of\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      pneumonia was based on clinical manifestations, radiological findings and microbiological testing results. Prognostic factors and risk factors for ESBL production were determined with univariate and multivariate logistic regression analysis. Empirical therapy and antimicrobial susceptibility data were also collected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 477\u2009\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      pneumonia patients, 60 were enrolled into this study. The in-hospital mortality was 28.3%. Septic shock, ICU admission, the need for mechanical ventilation and change of antibiotics due to clinical deterioration, all related to mortality, were included as unfavorable clinical outcomes. Multivariate analysis suggested that ESBL production (OR, 6.793;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012), initial PCT\u2009\u2265\u20090.5\u2009ng\/ml (OR, 5.024;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033) and respiratory failure at admission (OR, 4.401;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046) predicted increased mortality. ESBL production was significantly associated with dose of corticosteroids (OR, 1.033;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008) and CMV viremia (OR, 4.836;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032) in patients with rheumatic autoimmune diseases. Abnormal leukocyte count (OR, 0.192;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.036) was identified as a protective factor of ESBL-producing\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      pneumonia. The most commonly used empirical antibiotic was ceftazidime, while most isolates showed less resistance to carbapenems and amikacin in susceptibility testing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      pneumonia could be life-threatening in patients with rheumatic autoimmune diseases. Our findings suggested that ESBL production, initial PCT\u2009\u2265\u20090.5\u2009ng\/ml and respiratory failure at admission were independent factors associated with poor prognosis. Dose of corticosteroids and CMV viremia, predicting ESBL production in\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      pneumonia, may help make individualized antibiotic decisions in clinical practice.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-021-06055-1","type":"journal-article","created":{"date-parts":[[2021,4,17]],"date-time":"2021-04-17T11:02:34Z","timestamp":1618657354000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Klebsiella pneumoniae pneumonia in patients with rheumatic autoimmune diseases: clinical characteristics, antimicrobial resistance and factors associated with extended-spectrum \u03b2-lactamase production"],"prefix":"10.1186","volume":"21","author":[{"given":"Yang","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yecheng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiayuan","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anlei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuezhong","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihai","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huadong","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,17]]},"reference":[{"issue":"13","key":"6055_CR1","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1056\/NEJMoa1306801","volume":"370","author":"SS Magill","year":"2014","unstructured":"Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. 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Written informed consent was waived by the Medical Ethics Committee of Peking Union Medical College Hospital due to the anonymized retrospective nature of the analysis.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"366"}}