Clinical and microbiological epidemiology of <i>Klebsiella pneumoniae</i> invasive disease in hospitalized adults in Johannesburg, South Africa: a multicentre observational study

Background: invasive disease (KPn-ID) in Africa. We conducted a multicentre, observational study on the clinical and microbiological epidemiology of KPn-ID in hospitalized adults in South Africa, focusing on clinical outcomes and KPn susceptibility profiles. Methods: Surveillance for culture-confirmed KPn from blood and CSF was undertaken from 15 May 2023 to 14 May 2024. Phenotypic antimicrobial susceptibility was analysed, and the presence of carbapenemases was assessed with a lateral flow assay test. Results: We enrolled 524 of 617 individuals with KPn-ID. The median age was 48 (IQR: 35-61) years, and 84.4% (442/524) were presumed healthcare-associated infections. Comorbidities included HIV (26.9%; 141/524) and diabetes mellitus (16.4%; 86/524). There was a high prevalence of carbapenem resistance (55.0%; 288/524), with the OXA-48 carbapenemase detected in 71.5% (181/253), and OXA-48 and NDM co-detected in 20.9% (53/253) of tested isolates. Colistin resistance was detected in 7.6% (19/251) of tested isolates. The in-hospital case fatality risk (CFR) was 56.5% (296/524). Urethral catheterization [adjusted odds ratio (aOR) 3.30; 95% CI: 1.51-7.23] and an admission quick sepsis-related organ failure assessment score of 1 to 3 (aOR 2.14; 95% CI: 1.25-3.68) were independently associated with in-hospital death. Achieving source control was associated with lower odds of death (aOR 0.18; 95% CI: 0.10-0.30). Conclusions: We observed a high prevalence of MDR and high CFR in adults with KPn-ID. These data show the urgent need for strategies to mitigate KPn-ID in settings such as ours.