| Background:Carbapenem-Resistant Klebsiella Pneumoniae(CRKP)is defined as one Klebsiella pneumoniae(KP)that is resistant to any of the carbapenem(such as meropenem,Doripenem,imipenem,ertapenem)or carbapenem-producing KP.Resistance reported from China antimicrobial surveillance network(CHINET)show that the detection rate of CRKP is increasing year by year.Carbapenem is originally one of the main therapeutic drugs for extended-spectrum β-lactamase(ESBLs)producing KP.CRKP greatly increases the difficulty of treatment and is an independent risk factor for death.CRKP carries a variety of drug resistance genes and has a high resistance rate to commonly used antibiotics.It has gradually become a major clinical challenge.As one of the important drugs,the sensitivity break point of tigecycline has different standards.The latest standard of European Joint Committee on Drug susceptibility Testing(EUCAST)considers that the MIC≤0.5 mg/1 is regarded sensitive.In China,the MIC ≤2 mg/1 is regarded as sensitive according to the standard of Food and Drug Administration of the United States(FDA).Therefore,most of the domestic studies are based on the standard of the FDA to judge the sensitivity of tigecycline.Therefore,it is necessary to analyze the clinical characteristics of CRKP infection and the efficiency of tigecycline with different sensitivities.PurposeBy analyzing the general clinical data of CRKP infected patients in Shandong and the changes in different years,the drug-resistance migration of CRKP strains,the risk factors for ineffective treatment,and the therapeutic effects of tigecycline with different sensiti vities,the data of clinical research on CRKP in China were supplemented.Methods:The clinical data of 178 patients with CRKP infection in Shandong Province Hospital from 2015.12 to 2019.12 were collected and analyzed.The clinical features and changing trends and risk factors of ineffective treatment were analyzed.According to the MIC of tigecycline,the patients were divided into two groups:low sensitivity group(2mg/1≥MIC>0.5mg/l)and high sensitivity group(MIC≤0.5mg/l),The therapeutic effects of the two groups were compared.Results:1.The cross-sectional study of CRKP infectionThere are 178 cases of CRKP infection,including 124 males(69.66%)and 54 females(30.34%).In the distribution of age,the number of patients aged from 29 days to 1 year old was the biggest,47 cases(26.40%),followed by 0-28 days,30 cases(16.85%),19 cases 61-70 ages(10.67%),and fewer patients in other age groups.The specimens were mainly from the intensive care unit,84 cases(47.19%),followed by neonatal pediatrics,28 cases(15.73%),pediatrics,17 cases(9.55%),and others from respiratory medicine,hematology,trauma department,and so on.The main specimens of CRKP were sputum,106 cases(59.55%),blood,18 cases(10.11%),skin and soft tissue secretions,15 cases(8.43%),and urine,ascites,bile,and so on.In terms of treatment,26 cases(14.61%)received reasonable empirical treatment and 81 cases(45.51%)received reasonable etiological treatment.In terms of prognosis,104 cases(58.43%)were an improvement,25 cases(14.04%)died in hospital,and 49 cases(27.53%)were discharged automatically.The total median hospital stay was 28 days,the quartile interval was 16-51 days,and the median post-infection hospital stay was 14 days.The quartile interval is 7-27.25 days.2.Changes in different yearsIn the past four years,the proportion of patients in infant group and young group decreased from 56.25%to 40.63%and 25.00%to 11.46%;the proportion of elderly group and middle-aged group increased from 12.50%to 28.13%and 0.00%to 11.46%;the number of departments which detected CRKP increased from 10 to 23;the proportion of intensive care unit decreased from 50%to 45.83%.The proportion of non-intensive care units increased from 50%to 54.17%.The resistance rate to tigecycline and polymyxin B was the lowest.The resistance rate of tigecycline was 0%(0/4)from 2016.12 to 2017.12 and 8%(2/25)from 2017.12 to 2018.12 and 1.39%(1/72)from 2018.12 to 2019.12.The resistance rate of Polymyxin B was 0%(0/3)from 2017.12 to 2018.12 and 1.52%(1/66)from 2018.12 to 2019.12.Followed by sulfamethoxazole,amikacin,levofloxacin,and so on.The resistance rate to cefoperazone/sulbactam,ceftazidime and cefepime was more than 95%.From 2015 to 2019,the resistance rate of CRKP to amikacin,gentamicin,levofloxacin,and ciprofloxacin increased year by year.It is worth mentioning that the drug resistance rate of the sulfamethoxazole compound decreased.3.Prognostic factorsIn adult patients,univariate analysis showed that the risk factors of ineffective treatment were high CCI(P=0.002),tracheotomy(P=0.017),mechanical ventilation(P=0.000),invasive operation(P=0.011),and hospitalization in intensive care units(P=0.000)respectively.Multivariate analysis showed that high CCI(OR=1.301 95%CI 1.040-1.628,P=0.021)and mechanical ventilation(OR=6.142,95%CI 1.124-33.548,P=0.036)were independent risk factors for ineffective treatment.In non-adult patients,univariate analysis showed that mechanical ventilation(P=0.001)and invasive operation history(P=0.056)were risk factors for clinical inefficacy,while multivariate analysis showed that mechanical ventilation history was an independent risk factor(OR=6.878 95%CI 1.830-25.844,P=0.004).4.Comparison of the efficiency of low sensitivity group and high sensitivity groupThere were 15 cases in the low sensitivity group and 22 cases in the high sensitivity group.There was no significant difference in total hospitalization days,post-infection hospitalization days,changes in infection index,treatment inefficiency,and mortality between the two groups(P>0.05).There was no significant difference in Kaplan-Meier analysis between the groups(P>0.05).Conclusion:CRKP has a high resistance rate to commonly used antibiotics.CRKP-infected patients has high ineffective rate,high mortality rate,and long hospitalization,which is a great challenge in clinical work.Most of the infected patients are infants,the elderly,and males.High CCI and mechanical ventilation can be the risk factors for ineffective treatment.We should strengthen the control of the special populations,pay strict attention to hand hygiene,strengthen contact isolation,manage the use of antibiotics according to standards,and reduce the incidence of risk factors related to treatment inefficacy.In addition,a highly sensitive tigecycline could not significantly improve the effective rate and survival rate. |
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