Visualized Analysis Of Global Scientific Research And The Mechanism And Control On Carbapenem-Resistant Klebsiella Pneumoniae In A Tertiary-Care Teaching Hospital

Objective:Carbapenem-resistant Klebsiella pneumoniae(CRKP)is considered as a serious global threat.This study aims to evaluate and analyze global research activities related to CRKP in 20 years and may provide a direction of hot topics and future research trends.And further investigate and control the first outbreak of CRKP in our hospital occurred between October 2017 and August 2019.1.Visualized analysis of global scientific research on carbapenem-resistant Klebsiella pneumoniae(2000-2019)Methods:Publications about CRKP from 2000 to 2019 were scanned in the Web of Science(WoS)collection database.Retrieved documents were limited to journal articles.Quantitative and qualitative analysis on retrieved research were using bibliometric indicators and visualization maps.Results:1813 publications were included in this study.Total number of publications and research interests in this area have shown a strong rising trend in recent years.The largest number of publications was published in 2019.Publications from the United States of America have the highest H-index(74),number of publications(517 publications)and total citation frequency(23660),while Sweden has the highest average citation frequency(90.48).The U.S.Department of Veterans Affairs was the most contributive institution(77publications)and Antimicrobial Agents and Chemotherapy journal(IF: 4.904,2019)published the most research(204 publications).The published literature has roughly divided into three topics: resistance mechanism studies,infection control and drug treatment.2.Drug resistance mechanism of carbapenem-resistant Klebsiella pneumoniae Methods:Carbapenemase genes were detected by modified carbapenem inactivation method(m CIM)test and the EDTA-modified carbapenem inactivation method(e CIM)test.Resistance genes were identified by polymerase chain reaction(PCR)and sequencing.Genetic relatedness was studied by multilocus sequence typing(MLST).Results:During the outbreak,31 patients were infected with CRKP isolates.20(64.5%)patients were infected with KPC-2 and/or NDM-1 producing K.pneumoniae.Only one strain was found to express 2 types carbapenemases which were KPC-2 and NDM-1.6/31 K.pneumoniae isolates were found to harbor genes encoding ESBLs.Mostly MLST-sequence types belonged to ST11(21/31).3.Infection control of carbapenem-resistant Klebsiella pneumoniae Methods:A total of 31 non-duplicated CRKP strains were isolated and identified from October2017 to August 2019.All clinical and epidemiological data were retrospectively reviewed.At the same time,the effectiveness of infection control measures of AMS(The antimicrobial stewardship)team was investigated and evaluated.Results:From the October 2017 to August 2018,a total of 26 patients with KPC-2 and/or NDM-1 CRKP were found in ten different wards(including ICU),all with an epidemiological connection to the outbreak.With all precautions in place,the outbreak began to wane in September 2018 with only few newly infected patients and no additional spread in the most affected wards.A total of 31 patients were affected.In 17(54.8%)patients CRKPs were isolated from respiratory secretions.The age range of the patients was from 30 to 95 years,with an average age of 62.4 years.The average number of days spent in hospital was 38.0 days.The average number of days for infection development after first detection of CRKP from patients was 21.0 days.A total of 45.2% of CRKP patients received carbapenem-including treatment in the 90 days before the strains isolated.Among all the patients in this study,11(33.3%)died during their hospitalization which the CRKP infection contributed to their death.The outbreak was two major K.pneumoniae clusters present in epidemiologically linked patients.Conclusion:1.CRKP literature has witnessed a sharp growth in the last two decades.Scientific and medical research have been done for CRKP,put forward to treatment methods and contain its spread.2.Resistance mechanism research and effective drug therapy are still future study trends.Global attentions should be paid to resistance mechanism studies,drug treatment and infection control for CRKP and it still has a long way to go.3.Setting up AMS workers is potentially a highly efficient strategy for the successful control of the outbreak.A multimodal and multidisciplinary infection control strategy proved to be crucial.4.The emergence of CRKP in our hospital emphasizes the importance of continuous monitoring of these isolates,which helps to limit the spread of CRKPs and improve the level of management.