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The increasing antimicrobial resistance among <jats:italic>K. pneumoniae<\/jats:italic> strains poses a critical challenge to effective treatment. This study aimed to assess the appropriateness of initial antimicrobial therapy, determine the 30-day all-cause mortality rate, and identify predictors of mortality among patients infected with <jats:italic>K. pneumoniae<\/jats:italic> in Lebanese hospitals.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A multicenter retrospective observational study was conducted across three university hospitals in Beirut, Lebanon. The study included hospitalized adult patients with confirmed <jats:italic>K. pneumoniae<\/jats:italic> infections. Kaplan-Meier survival analysis and log-rank tests were used to analyze time-to-mortality. Binary logistic regression was performed to identify predictors of mortality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of 2,655 cases screened, 410 patients were enrolled, and 395 cases were included in the final analysis of the 30-day mortality after excluding those lost to follow-up. Nearly one-third of the isolates (36.8%) were extended-spectrum \u03b2-lactamase (ESBL)-producing, while 6.8% were carbapenem-resistant <jats:italic>K. pneumoniae<\/jats:italic> (CRKP). The most commonly prescribed empirical antibiotics were meropenem (31.7%), amikacin (28.5%), and ceftriaxone (22.2%). Around one-third of the patients (32.9%) received inappropriate initial antimicrobial therapy. The 30-day mortality rate was 14.4%. Main predictors significantly associated with mortality in patients with <jats:italic>K. pneumoniae<\/jats:italic> infection were solid cancer (adjusted odds ratio [AOR]\u2009=\u20097.82, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01), coronary artery disease (AOR\u2009=\u20094.81, <jats:italic>P<\/jats:italic>\u2009=\u20090.01), age\u2009\u2265\u200965 years (AOR\u2009=\u20094.22, <jats:italic>P<\/jats:italic>\u2009=\u20090.02), type II diabetes mellitus (AOR\u2009=\u20093.96, <jats:italic>P<\/jats:italic>\u2009=\u20090.01), receiving inappropriate initial antimicrobial therapy (AOR\u2009=\u20092.96, <jats:italic>P<\/jats:italic>\u2009=\u20090.02), infection with CRKP isolates (AOR\u2009=\u20092.53, <jats:italic>P<\/jats:italic>\u2009=\u20090.03), and having a higher Charlson comorbidity index (AOR\u2009=\u20091.61, <jats:italic>P<\/jats:italic>\u2009=\u20090.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The study highlights the critical need for effective antimicrobial stewardship and tailored infection control protocols to mitigate the high resistance rates and improve patient outcomes in Lebanon. Emphasis should be placed on enhancing the monitoring of local resistance patterns and using these data to guide the selection of appropriate empirical therapy to reduce mortality associated with <jats:italic>K. pneumoniae<\/jats:italic> infections.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12879-025-11010-5","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T13:39:16Z","timestamp":1745847556000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Management practices and mortality predictors among Klebsiella pneumoniae infections across Lebanese hospitals: a multicenter retrospective study"],"prefix":"10.1186","volume":"25","author":[{"given":"Rania","family":"Itani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani M. 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It received approval from the institutional review board (IRB) at Beirut Arab University (Approval code: 2023-H-0089-P-R-0532) and from the IRBs and ethical committees of the participating hospitals (Hospital 1: 2023-IRB-012, Hospital 2: HOP-2023-006, Hospital 3: 6\/2023). Data collection involved a comprehensive review of de-identified and anonymized patients\u2019 medical records to ensure privacy and confidentiality. The research team did not engage in any direct contact or follow-up with the patients. 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