ArticleInternational health2026
Antimicrobial resistance analysis of Klebsiella pneumoniae bloodstream infections based on a random forest algorithm: a longitudinal study based on data from tertiary hospitals in China from 2012 to 2023.
Article in International health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBloodstream infections (BSIs) caused by Klebsiella pneumoniae pose a significant global health burden, complicated by rising antimicrobial resistance (AMR). This study aimed to characterize resistance patterns, identify predictors of carbapenem resistance, and develop a machine learning model to predict patient outcomes.
methodsIn a retrospective analysis of 109 279 K. pneumoniae BSIs from tertiary hospitals in China (2012-2023), 11 000 isolates underwent whole-genome sequencing (WGS) and antimicrobial susceptibility testing. Cox proportional hazards and logistic regression models identified predictors of 30-day mortality and carbapenem-resistant K. pneumoniae (CRKP), respectively. A random forest model predicted AMR trends and outcomes, evaluated by accuracy, precision, recall, and ROC-AUC using R Studio (R Studio, Inc., Boston, MA, USA).
resultsCarbapenem resistance occurred in 32.3% of isolates, with rates of 41.9% for third-generation cephalosporins and 41.2% for fluoroquinolones. Among sequenced isolates, ST11 with blaKPC was the dominant CRKP genotype (12.0%). blaKPC (OR 3.97, 95% CI 3.10-5.11) and blaNDM (OR 2.80, 95% CI 2.07-3.71) strongly predicted carbapenem resistance; ICU admission predicted 30-day mortality (HR 2.10, 95% CI 1.80-2.46, p<0.001). Mortality was higher in CRKP (40.2%) vs. susceptible cases (21.5%). The random forest model achieved 89.2% accuracy and 0.92 ROC-AUC, with drug share, age, and CRKP status as top predictors.
conclusionsCRKP, especially ST11-blaKPC, drives excess mortality. Key predictors highlight the urgency for enhanced AMR surveillance and targeted therapy.
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