Clinical Characteristics And Post-Treatment Infection Of Community Acquired Klebsiella Pneumoniae Pneumonia In Primary Hospitals Parameter Variation

Objective Over the past decade,carbapenem-resistant Klebsiella pneumoniae(Kp)infection rates in primary hospital communities have increased year by year,becoming a matter of great concern.To study the clinical characteristics and post-infection parameter changes of community-acquired Klebsiella pneumoniae pneumonia,and to study the prognoses related factors of patients infected with community-acquired Klebsiella pneumoniae pneumonia in primary hospitals,so as to reduce and delay the generation of multi-drug resistant bacteria.It also provides a basis for clinical evaluation of patients with community-acquired pneumonia,prognosis and guidance of treatment.It can improve the clinical cure rate and reduce the mortality rate of patients.Methods The general clinical data of 120 patients with community-acquired Klebsiella pneumoniae treated in The Medical Community of Zhuji City People’s Hospital,Zhejiang Province from January 1,2020 to December 31,2022 were selected for retrospective study.The inflammatory indicators were measured before treatment,and samples of blood,urine,pus and sputum were collected and cultured.The anti-infective therapeutic effect of all patients was followed up,and the patients were divided into two groups according to the prognosis:survival group and death group.The prognosis of community-acquired pneumonia Kp infection patients in primary hospitals was studied by univariate and Logistic factors.The categorical variables between different groups were analyzed by cross list and x2 analysis,and were analyzed by independent t test and one-way analysis of variance.Kp infection was analyzed by multivariate Logistic regression analysis,so as to reduce and delay the generation of multidrug-resistant bacteria of antibiotics and improve clinical cure rate.Results(1)Baseline situation of community-acquired Klebsiella pneumoniae pneumonia in primary hospitals:There were 78 males and 42 females in primary hospitals.The minimum age of patients was 50 years old and the maximum age was 85 years old.The average age of patients was(66.7±8.1)years old.The average BMI was(22.51±2.74)Kg/m2.There were 56 smoking patients and 61 drinking patients.There were 61 patients with diabetes mellitus,59 patients with coronary heart disease and 57 patients with cerebral infarction.The mean length of hospitalization was(21.3±17.8)days.(2)Source and department distribution of community-acquired Klebsiella pneumoniae pneumonia strains in primary hospitals:In primary hospitals,45 cases of community acquired Klebsiella pneumoniae pneumonia strain were admitted to the department of respiratory medicine,31 cases in the emergency department,15 cases in the department of infection,12 cases in the ICU,10 cases in gastrointestinal surgery,7 cases in the department of urology,among which the most admitted departments were respiratory medicine,emergency department and infection department.The strains were derived from blood culture in 58 cases,urine culture in 45 cases,pus culture in 10 cases and sputum culture in 7 cases.The strains were mainly derived from blood culture and urine culture.(3)Susceptibility and resistance of community acquired Klebsiella pneumoniae pneumonia to antibiotics in primary hospitals:Among 120 patients in this group,75 strains produced ESBLs,accounting for 62.5%;There were 35 non-EsBL-producing strains,accounting for 37.5%.The sensitivity of community acquired Klebsiella pneumoniae pneumonia to ampicillin,amoxicillin and furantoin was 0.1%,41.7%and 60.6%,respectively.The sensitivity to tobramycin,tegacycline,imipenem,ertapenem,meropenem and amtronem were 90.7%,95.8%,98.7%,98.8%,98.7%and 98.8%,respectively.(4)Univariate analysis of prognosis of community-acquired Klebsiella pneumoniae infection in primary hospitals:A total of 120 patients with community-acquired Klebsiella pneumoniae were collected in this study,including 91 patients in the survival group and 29 in the death group,with a survival rate of 75.83%.This study showed that combined underlying diseases:Coronary heart disease,chronic kidney disease,chronic obstructive pulmonary disease,non-invasive ventilation,central venous catheterization,hypoalbuminemia(<30g/L),other infections,septic shock,CRP>10mg/L,WBC>4.0×10^9/L,PCT>0.5ng/mL,NEU>75%and the difference was statistically significant(X2=9.86,8.91,8.65,7.93,8.92,8.83,8.59,10.053,9.418,8.041,8.935,9.003,8.942,P<0.05).(5)Logistic multivariate analysis of prognosis of community-acquired Klebsiella pneumoniae infection in primary hospitals:Logistic multivariate analysis was performed on the single factor with statistical significance for the prognosis of Klebsiella pneumonia infection.Studies showed that there was statistical significance in combination with other infections,septic shock,CRP>10mg/L,NEU>75%,and non-invasive ventilation(Wald value was 3.214,2.615,1.223,1.513,1.009,0.984,respectively.The P values were 0.001,0.015,0.007,0.001,0.008,0.009).(6)Adverse drug reactions of community acquired Klebsiella pneumoniae pneumonia survival group and death group during medication in primary hospitals:Adverse drug reactions occurred in the survival group of community-acquired Klebsiella pneumoniae pneumonia,such as diarrhea in 1 case,liver function injury in 1 case,increased creatinine level in 2 cases,red and swollen veins in both upper limbs in 1 case,rash in 1 case,nausea and vomiting in 1 case.In total.adverse drug reactions occurred in 7 cases in the survival group.In the death group,there were 1 case of adverse drug reactions such as diarrhea,1 case of red and swollen veins in both upper limbs,and 1 case of rash.In total,there were 3 cases of adverse drug reactions in the death group,and there was no statistical significance between the two groups(t=0.736,P>0.05).Conclusion First,community-acquired Klebsiella pneumoniae pneumonia in primary care hospitals has a low sensitivity to β-lactam antibacterial drugs such as ampicillin,amoxicillin and furantoin,and a high sensitivity to glycylcycline antibacterial drugs,carbapenems,aminoglycosides,antibiotics such as tobramycin,tigecycline,imipenem,ertapenem,meropenem and aminotrans,Second,the survival rate of community-acquired Klebsiella pneumoniae in this primary care hospital was 75.83%with combined underlying diseases:coronary artery disease,chronic kidney disease,chronic obstructive pulmonary disease,invasive and noninvasive ventilation,multiple organ failure,with or without central venous placement,hypoalbuminemia(10 mg/L,WBC>4.0×10^9/L,PCT>0.5 ng/mL,and NEU>75%were statistically significant differences(all P<0.05).Third,logistic multifactorial analysis showed that co-infection with other infections,having infectious shock,and having invasive ventilation were statistically significant(all P<0.05).