Clinical Characteristics,Pathogen Distribution And Drug Resistance Analysis Of Chronic Kidney Disease Patients With Pneumonia

Objective:1.To analyze the clinical characteristics,pathogen distribution and drug resistance of chronic kidney disease patients with pneumonia.2.To explore the risk factors of severe pneumonia in patients with CKD.3.To explore the risk factors of severe pneumonia in CKD patients treated with glucocorticoid / immunosuppressant.Methods:The relevant data of adult patients with chronic kidney disease complicated with pulmonary infection treated in the Department of Nephrology of the First Affiliated Hospital of Nanchang University from January 2013 to January 2020 were collected.Firstly,the clinical characteristics,Etiological Distribution and drug resistance of patients with CKD complicated with pulmonary infection were analyzed.Secondly,according to the severity of infection,they were divided into severe pneumonia group and non-severe pneumonia group.The two groups were compared,and logistic regression was used to explore the independent risk factors of severe pneumonia in CKD patients.Then,according to whether glucocorticoid / immunosuppressant is used in the treatment process,it is divided into use group and non-use group.The differences in clinical data,Etiological Distribution and drug resistance rate between the two groups are compared,and the effect of glucocorticoid / immunosuppressant on CKD complicated with pulmonary infection is analyzed.Finally,patients using glucocorticoids / immunosuppressants were divided into severe pneumonia group and non-severe pneumonia group according to the severity of infection.To explore the independent risk factors of severe pneumonia in CKD patients treated with glucocorticoids / immunosuppressants.Results:1.313 adult CKD patients with pneumonia were included in this study.Gramnegative bacteria were the main pathogens(90.9%),and the top 3 pathogens were Klebsiella pneumoniae(19.1%),Acinetobacter baumannii(17.7%),Pseudomonas aeruginosa(15.1%).In terms of drug sensitivity,klebsiella pneumoniae had higher drug resistance rates to ampicillin(50.7%),ciprofloxacin(34.3%)and ampicillin sulbactam(28.4%)among gram-negative bacteria.Acinetobacter baumannii had higher drug resistance rates to ceftazidime(30.6%),ampicillin(25.8%)and amoxicillin clavulanate potassium(20.9%).The resistance rates of Pseudomonas aeruginosa to ceftriaxone(58.5%),ampicillin(54.7%)and ampicillin sulbactam(49.1%)were higher.2.Compared with the non-severe pneumonia group,the severe pneumonia group had a higher proportion of multiple drug-resistant bacteria infection(22.9% vs 6.7%,P<0.001).The drug resistance rates of Klebsiella pneumoniae in severe pneumonia group to imipenem(33.3% vs 9.6%),acinetobacter baumannii to gentamicin(40.0%vs 10.6 %)and tobramycin(40.0% vs 10.6 %),Pseudomonas aeruginosa to imipenem(28.6% vs 5.1%),piperacillin tazobactam(28.6% vs 2.6%),ceftazidime(28.6% vs2.6%)and levofloxacin(28.6% vs 2.6%)were significantly higher than those in nonsevere groups(P<0.05).Multivariate Logistic analysis showed that hypoproteinemia(OR=0.938,95%CI: 0.888～0.992,P=0.024),thrombocytopenia(OR=0.980,95%CI:0.974～0.992,P<0.001)and multiple drug-resistant bacterial infection(OR=8.945,95%CI:2.813～28.439,P<0.001)were independent risk factors for severe pneumonia in CKD patients.3.The top 3 pathogens of CKD patients with pulmonary infection using glucocorticoids/immunosuppressant were Pseudomonas aeruginosa(16.5%),Acinetobacter baumannii(15.5%)and Klebsiella pneumoniae(12.4%).Compared with patients without using glucocorticoids/immunosuppressant,the rate of Escherichia coli(11.3% vs 4.3%),Haemophilus influenzae(10.3% vs 2.8%)was higher in the using group,while the rate of Klebsiella pneumoniae(12.4% vs 21.7%)was lower(P <0.05).The resistance rate of Klebsiella pneumoniae to ampicillin in the using group was significantly lower than that patients without using glucocorticoids/immunosuppressant(25.0% vs 63.6%,P < 0.05).4.In multivariate Logistic analysis,cumulative glucocorticoid(OR=1.628,95%CI:1.046～3.172,P=0.035),low e GFR(OR=0.732,95%CI:0.590～0.954,P=0.027)and thrombocytopenia(OR=0.673,95% CI: 0.491-0.895,P=0.022)were independent risk factors for severe pneumonia in patients using glucocorticoid/ immunosuppressant.Conclusions:(1)The main pathogen of CKD patients with pulmonary infection is Gramnegative bacteria,and the pathogen with the highest detection rate is Klebsiella pneumoniae,while the most common pathogen of CKD patients treated with glucocorticoid / immunosuppressant is Pseudomonas aeruginosa.From the results of drug sensitivity,the drug resistance rate of Klebsiella pneumoniae to ampicillin,ciprofloxacin,ampicillin and sulbactam was high;The resistance rate of Acinetobacter baumannii to ceftazidime,ampicillin,amoxicillin and clavulanate potassium was high;The resistance rate of Pseudomonas aeruginosa to ceftriaxone,ampicillin,ampicillin and sulbactam was high.(2)Hypoproteinemia,thrombocytopenia and multidrug-resistant bacterial infection are independent risk factors of severe pneumonia in patients with CKD.(3)Cumulative glucocorticoid in 3 months before infection,low e GFR and thrombocytopenia are independent risk factors for severe pneumonia in CKD patients treated with glucocorticoid / immunosuppressant.