Analysis Of Drug Resistance Characteristics And Risk Factors Of Bloodstream Infection In Carbapenem-resistant Klebsiella Pneumoniae

Objective By detecting the resistance genes of carbapenem-resistant Klebsiella pneumoniae,analyzing drug resistance characteristics and risk factors of bloodstream infection in carbapenem-resistant Klebsiella pneumoniae,it is guided the clinical rational application of intibacterial drugs and provided an experimental basis for effective infection control.Therefore reducing the morbidity and mortality associated with CRKP-BSI.Methods 206 strains of K.pneumoniae BSI isolated from inpatients in the First Affiliated Hospital of Dalian Medical University from 2017 to 2018 were identified.The antimicrobial sensitivity test was carried out by the minimum inhibitory concentration(MIC)method and K-B disc diffusion method.Comparing drug resistance rates with χ2 and P values.Carbapenem-resistant genes were detected by PCR and agarose gel electrophoresis.Logistic regression analysis was used to count risk factors for K.pneumoniae strains with resistance to carbapenem antibiotics(n=55).Kaplan-Meier survival analysis was used to assess survival differences between the CRKP and CSKP groups.Results It is lower that the resistance rates of CRKP to aminoglycoside antibiotics amikacin,tobramycin and gentamicin were 52.73%(29/55),67.27%(37/55)and 70.91%(39/55)respectively.The bloodstream infection of K.pneumoniae in the two years of 2017 and 2018 had the highest resistance rate to piperacillin,which was 66.98%(71/106)and 61%(61/100),respectively.The resistance rate of amikacin was the lowest,18.87%(20/106)and 13.00%(13/100),respectively.There was a statistically significant difference in the resistance rate of cefazolin,cefuroxime,cefoxitin tobramycin and gentamicin in the two years(*P<0.05),and the resistance rates of these five antibiotics was lower in 2018 than that in 2017.Only 55 strains isolated CRKP resistance genes of KPC-2 and NDM-1 was be detected,and mainly KPC-2,accounting for 85.45%(47/55).Multivariate regression analysis showed central venous catheter,diabetes,indwelling drainage tube,endotracheal intubation,mechanical ventilation,application of third and fourth generation cephalosporin antibiotics,β-lactam + enzyme inhibitor,carbapenem antibiotics,admission time before bacteremia are an independent risk factor for carbapenem antibiotic resistance.Analysis of associated risk factors showed that t The 28-day mortality rate of patients with bloodstream infection of CRKP group was significantly higher than that of CSKP group(*P<0.05).The difference was statistically significant.Conclusion The multidrug resistance of CRKP is serious.Clinically,it should be based on independent risk factors of CRKP-BSI,adopt process management to strengthen invasive operation,regulate the use of antibiotics,strengthen hospital infection monitoring,shorten hospitalization time,etc.,thereby reducing CRKP-BSI.Morbidity and mortality...