Factors associated with Klebsiella pneumoniae colonisation in adults hospitalised in Johannesburg, South Africa

Background: There is a paucity of data on gastrointestinal colonisation with Klebsiella pneumoniae (KPn) in African adults, although it is a known risk factor for developing KPn invasive disease (KPn-ID). Objectives: We investigated the risk factors for KPn gastrointestinal colonisation among a cohort of hospitalised adults without KPn-ID in South Africa, and described their clinical outcomes. Method: A cohort of hospitalised adults without KPn-ID was enrolled between 15 May 2023 to 14 May 2024 across three hospitals in Johannesburg, South Africa. Study participants had rectal swab cultures performed once, at enrolment, to determine the presence or absence of KPn gastrointestinal colonisation, and were followed up until in-hospital death or discharge. Results: Among the cohort of hospitalised adults without KPn-ID (n = 651), the rate of KPn gastrointestinal colonisation was 34.4% (224/651). Risk factors for KPn colonisation were peptic ulcer disease (adjusted odds ratio [aOR] 7.75; 95% confidence interval [CI]: 1.34-44.78), a central venous catheter (aOR 3.07; 95% CI: 1.00-9.40), a presumed healthcare-associated infection (pHAI) (aOR 3.13; 95% CI: 1.06-9.28), and length of stay more than seven days prior to enrolment (aOR 1.84; 95% CI: 1.23-2.75). There was no difference in in-hospital case fatality risk (CFR) between participants with (3.1%; 7/224) and without (3.0%; 13/427, p = 0.955) KPn colonisation. Conclusion: KPn gastrointestinal colonisation rates among hospitalised adults without KPn-ID were higher than that of high-income settings and also varied between study sites. Length of hospital admission prior to swabbing and pHAI were associated with KPn colonisation, suggesting that infection prevention control measures play a significant role in KPn colonisation. Contribution: Large prospective cohort studies and community surveillance studies are required in settings such as ours to further investigate KPn colonisation dynamics and explore preventive strategies against KPn-ID.