Clinical characteristics and 28-day outcomes of sepsis associated with klebsiella pneumoniae carbapenemase-producing Enterobacterales: a single-center retrospective cohort study.

BACKGROUND: Sepsis caused by carbapenemase-producing Enterobacterales, particularly Klebsiella pneumoniae carbapenemase (KPC)-producing strains, is associated with high mortality and limited treatment options. However, data regarding dynamic organ dysfunction and prognostic factors in this population remain limited. OBJECTIVE: To compare the clinical characteristics and outcomes of sepsis due to KPC-producing versus non-KPC-producing Enterobacterales and to identify independent predictors of 28-day mortality. METHODS: In this single-center retrospective cohort study, 320 intensive care unit (ICU) patients with sepsis and microbiologically confirmed Enterobacterales infection (January-December 2024) were included. Patients were classified as KPC (n = 210) or non-KPC (n = 110) using the NG-Test CARBA 5 assay, with polymerase chain reaction (PCR) confirmation when available. The primary outcome was 28-day all-cause mortality from sepsis onset. Multivariable logistic and Cox regression analyses were performed. RESULTS: The KPC group had significantly higher 28-day mortality than the non-KPC group (35.2% vs. 23.6%, odds ratio [OR] = 1.77, 95% confidence interval [CI]: 1.04-3.00, P = 0.030). KPC infection remained independently associated with mortality after adjustment (adjusted OR [aOR] = 1.58, 95% CI: 1.02-2.44, P = 0.04). Additional independent risk factors included higher Day-1 Sequential Organ Failure Assessment (SOFA) score (aOR = 1.08), elevated lactate level (aOR = 1.12), and inadequate early antimicrobial therapy (aOR = 1.69; all P < 0.05). In the KPC subgroup, ΔSOFA, positive fluid balance, and low albumin levels were also associated with mortality. CONCLUSION: Sepsis caused by KPC-producing Enterobacterales is associated with more severe organ dysfunction and increased short-term mortality. Early administration of appropriate antimicrobial therapy, along with optimized organ support and fluid management, may improve clinical outcomes. CLINICAL TRIAL NUMBER: Not applicable.