| Objective To record the detection and antibacterial susceptibility test results of patients with carbapenem-resistant Klebsiella pneumoniae（CRKP）bloodstream infection（BSI）in our hospital.To compare the clinical characteristics of patients between CRKP group and carbapenem-susceptible Klebsiella pneumoniae（CSKP）group in patients with hospital-acquired Klebsiella pneumoniae（KP）BSI and analyze the risk factors of CRKP BSI,in order to assist clinicians in early identification and prevention of CRKP BSI.Methods Through the medical record review system of the First Affiliated Hospital of Anhui Medical University,the department distribution and annual detection rate of 396 KP BSI patients in our hospital from January 2016 to December 2020 were recorded.226 adult hospital-acquired KP BSI patients with complete case data and meeting the inclusion conditions were included in the retrospective analysis and divided into CSKP BSI group and CRKP BSI group.Continuous variables were analyzed by independent samples t test or Mann-Whitney U test according to their normality,and categorical variables were compared by chi-square test or Fisher’s exact probability test.Multivariate analysis of risk factors for CRKP BSI was performed using binary logistic regression analysis.Results1.From 2016 to 2020,the detected numbers of KP BSI among the registered inpatients in our hospital were 64,71,67,80,and 114,respectively.The annual detection rate of KP BSI,hospital-acquired KP BSI and CRKP BSI among the total registered inpatients in our hospital increased from 0.050%,0.026% and 0.0094% in 2016 to 0.095%,0.069% and 0.036% in 2020.The proportion of CRKP in KP BSI patients trended upward over the 5-year period,from 18.75% in 2016 to 37.72% in 2020.2.The top three departments with the highest composition ratio of hospital-acquired KP BSI were intensive care unit（ICU）,hematology department and infectious disease department,accounting for 24.49%（97/396）,16.67%（66/396）,9.85%（39/396）.The top three departments with the highest composition ratio of hospital-acquired KP BSI were ICU,hematology department and kidney transplantation department,accounting for29.64%（75/253）,22.13%（56/253）and 7.51%（19/253）,respectively;The top three departments with the highest composition ratio of CRKP BSI were ICU,hematology department and kidney transplantation department,accounting for 45.32%（63/139）,13.67%（19/139）,and 12.23%（17/139）,respectively.3.139 cases of CRKP strains isolated from blood samples in our hospital were highly resistant to β-lactam antibiotics except the new β-lactam/β-lactamase inhibitor combinations（BLBLIs）,and the susceptible rate of amikacin was 39.57%（55/139）,which was the highest among aminoglycosides.The susceptible rate of fosfomycin was11.70%（11/94）,the susceptible rate of Trimethoprim-sulfamethoxazole（TMP-SMZ）was 57.55%（80/139）,the susceptibility rate of minocycline was 88.60%（101/114）,and the susceptibility rates of tigecycline,polymyxin B,ceftazidime/avibactam were all more than 90.00%.4.Patients in the CRKP group had a longer hospital stay before the collection of positive blood culture specimens（Z=-2.171,P=0.030）,There were statistically significant differences between the two groups in terms of admission to the ICU,septic shock,combined lower respiratory tract infection,and Pitt bacteremia score on the day of collection of positive blood culture specimens（P<0.050）.More patients in the CRKP group combined hypertension,renal disease,cerebral hemorrhage,and after solid organ transplantation,the differences were statistically significant（P<0.050）.The proportion of patients with a history of exposure to BLBLIs within 90 days was the highest at45.58%（103/226）,followed by Patients with a history of carbapenem exposure at42.48%（96/226）,antibiotic exposures in the CRKP group were more and the differences were statistically significant（P<0.050）.There were statistically significant differences in terms of indwelling gastric tube,indwelling urinary catheter,mechanical ventilation,central venous catheter,peripheral arterial catheter,blood purification treatment,bronchoscopes,thoracentesis,abdominal puncture,bone marrow puncture,craniocerebral surgery between the two groups（P<0.050）.5.The results of multivariate analysis indicated that the history of carbapenem exposure（P=0.030,OR=2.286,95%CI: 1.082-4.828）,admission to ICU（P=0.046,OR=3.818,95%CI: 1.027-14.195）,after solid organ transplantation（P<0.001,OR=10.684,95%CI:3.176-35.937）,combined with lower respiratory tract infection（P=0.007,OR=2.877,95%CI: 1.341-6.171）was independent risk factors for hospital-acquired CRKP BSI.Conclusion The incidence of CRKP BSI in our hospital has been increasing,more attention should be paid to patients admitted to the ICU or after solid organ transplantation.In addition to reducing hospital stay,antibiotic exposure and the number of invasive procedures,respiratory tract is likely to be one of the important sources of CRKP BSI. |
PDF Full Text Request