Postoperative risk of infection with klebsiella in adults - a retrospective case-control study

Objectives: Hospital-acquired infections with Klebsiella spp. and emerging multidrug-resistant strains are a persistent concern. Identifying high-risk groups is crucial for the evaluation of preventive interventions like vaccines. We determined the incidence and developed prediction models for postsurgical Klebsiella infections in adult elective surgery patients. Methods: This multicentre retrospective case-control study, in seven European hospitals, included patients ≥50 years old who underwent elective surgery between 2012 and 2021. Using multivariable logistic regression, we modelled the risk of postsurgical Klebsiella infection and investigated trial enrichment scenarios. Results: Of 139,778 eligible surgeries identified, 1,781 were included: 840 patients with postsurgical Klebsiella infection and 941 without. The incidence of postsurgical Klebsiella infection was 1.38% (95% CI 1.24-1.54%). Pre-surgical Klebsiella colonisation, gastrointestinal surgery, abdominal surgery, trauma surgery and chronic cardiovascular disease were independent predictors of postoperative Klebsiella infection. Minimally invasive surgery and peri-operative antibiotic prophylaxis predicted a lower risk. Trial enrichment simulation indicated a 72% reduction in required participants when enrolling patients with a predicted risk above 2%. Conclusions: A multivariable model incorporating Klebsiella colonisation status and clinical factors can accurately predict Klebsiella infections in elective surgery patients. This model can select high-risk patients, enhancing the efficiency of phase-III trials of preventive interventions, including vaccination.