| AIMKlebsiella pneumoniae is one of the most commonest bacteria which producing beta—lactamase. Since Klebsiella pneumoniae with ESBLs was first isolated in Germany in 1983, many outbreaks caused by multiresis-tant strains have been reported all over the world. The ratio of ESBLs producing isolates has become high .This assay studied the antimicrobial resistance and ESBLs detection of Klebsiella pneumoniae and analyze risk factors of ESBL — producing, offering experimental data for controlling , treatment and prevention of ESBL—producing strains infection.MATERIALS AND METHODSFrom 1 January 2002 to 30 October 2003, 422 isolates of Klebsiella pneumoniae identified by the antimicrobial laboratory in China Medical U-niversity were collected. Isolates were collected from sputum, blood, u-rine,pleural effusion and ascitic fluid,excretion of wound and cerebrospi-nal fluid et al. 77 of which were ESBLs—producing srains . The prevalence rate was 18. 2% (77/422). 120 patients with Klebsiella pneumoniae infection were chosen, of which 60 case patients (ESBLs —producing K. pneumoniae), male 33, female 27, and 60 controls (non— ESBLs — pro-ducing K. pneumoniae) , male 38, female 22. Bacteria susceptibility to nineteen antimicrobial agents was determined according to criteria of the National Committee for Clinical Laboratory Standards by means of Kirby — Bauer disk diffusion methods. Phenotypic Confirmatory Test was used to detect ESBLs according to NCCLS. The reference strains were Esche-richia coli ATCC 25922 and K. pneumoniae 700603.A 1:1 case — control study was performed in two group patients'data , fouteen possible factors were chosen, including : Tracheostomy (Xi), Urinary catheterization (X2), use of the third generation cephalosporins over 3 days(X3) , Medical history or underlying condition(X4), Cortico-steroid and immunosuppressive drug therapy(X5) , Surgery(X6) , Central venous catheter(X7) , Inhale oxygen (X$) , mechanical ventilation (X9), Venous peripheral(Xi0), age (Xn), Admitted to ICU(Xi2) ? Hospitaliza-tion time ^20 days(Xi3), prophylactic use of antibiotics (Xh) were analyzed by univariate analysis. Multivariated analysis was applied to all key variables,which were significantly associated with the outcome in univariate analysis by using a logistic regression model to identify the risk factors.RESULTSThe antimicrobial resistant rates of majority of ESBLs — producing strains were significant higher than non — ESBLs — producing strains , with the exception of imipenem and meropenem . Tracheostomy, Urinary catheterization, use of the third generation cephalosporins over 3 days, mechanical ventilation, Admitted to ICU, prophylactic use of antibiotics six factors were found to be risk factors in aquisition of K. pneumoniae with ESBLs by univariate analysis. Use of the third generation cephalosporins over 3 days (OR =3. 99 ,95%CI 1. 61 — 9. 93);invasive manipulation :insertion of a Forley Catheter (OR= 2. 84 , 95%CI 1. 17-6. 87) , mechanical ventilation (OR = 3. 44, 95% CI 1. 22 — 9.- 71) and admitted to ICU (OR = 3. 25, 95% CI 1. 16-9. 12 ) remained as independent riskfactors by multivariate analysis with logistic regression.DISCUSSIONKlebsiella pneumoniae with ESBLs is resistant to many antibiotics with the exception of imipenem and meropenem . To avoid carbapenem resistance due to a lot of empirical use of cabapenems, cabapenems appears to be the choice for serious infections due to Klebsiella pneumoniae with ESBLs, other alternatives such as piperacillin/tazobactam combined with aminoglycosides or quinolones is also recommended as a therapeutic choice for mild infection,or choice is according to Antimicrobial Susceptible test.More case patients than controls are regarded as having hospital—acquired infections, and have longer hospitalization durations ,high morbidity. Producing ESBLs caused by many risk factors, the main factors were use of the third generation cephalosporins, Admitted to ICU and invasive procedures. In conclusion we encourage reasonable use of the third generation cephalosporins and early removal of unnecessary interventional apparatus, try to reduce the ICU duration to decrease the prevalence of Klebsiella pneumoniae with ESBLs.CONCLUSION1. The antimicrobial resistant rates of majority of ESBLs — producing strains were significant: higher than non — ESBLs — producing strains , with the exception of imipenem and meropenem .2. More case patients than controls were regarded as having hospital — acquired infections, and have longer hospitalization durations , high morbidity.3. Producing ESBLs caused by many factors, use of the third generation cephalosporins, admitted to ICU and invasive procedures were independent risk factors. |
PDF Full Text Request