Clinical Characteristics And Prognostic Analysis Of Pulmonary Infection Caused By Extended-Spectrum β-Lactamase Producing Klebsiella Pneumoniae

Objective: To investigate the clinical features and prognostic risk factors of nosocomial acquired pulmonary infection(HAP)(including Ventilator associated pneumonia(VAP))caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae(ESBL-Kp).Methods: The general data and clinical data of 239 patients with nosocomial ESBL-Kp infection admitted to two tertiary teaching hospitals in Wuhu from January 2018 to July 2021 were analyzed retrospectively.Including age,sex,department of hospitalization,length of stay,type of infection,complications,other co-infected bacteria,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ),drug resistance of strains,co-infected with other bacteria,antibiotic type and treatment time.The patients were divided into death group(35 cases)and survival group(204 cases)according to their clinical outcomes.The general data and clinical data of the two groups were analyzed and statistically described.Multivariate Logistic regression analysis was used to explore the independent risk factors of death of ESBL-Kp patients with p < 0.05 variables.Results: 239 cases of ESBL-Kp infection were mainly distributed in neurosurgery department(60 cases,25.10%);Most patients were complicated with at least one basic disease,the most common one was cerebrovascular disease(107 cases,44.77%),followed by hypertension(91 cases,38.08%).There were significant differences in renal insufficiency(P=0.027)and liver insufficiency(P=0.020)between death group and survival group.Among all HAP patients,some patients belonged to VAP(70 cases,29.29%),and whether they were VAP(P=0.007)was statistically significant between the death group and the survival group.All 239 strains of ESBL-Kp were completely resistant to ampicillin,with high resistance rates to cefazolin,ampicillin/sulbactam,ceftriaxone,nitrofurantoin and aztreonam,all of which were > 80%,while the resistance rates to piperacillin/tazobactam,cefotetan,imipenem,amikacin and ertapenem were relatively low,all of which were < 30%.There were more patients with other respiratory bacterial infections(77 cases,32.2%),among which Acinetobacter baumannii(29 cases,12.1%)was the most common;The median APACHE Ⅱ score of death group and survival group was 17(IQR12,23),which was significantly higher than that of survival group 13(IQR9,17),and the difference of APACHE Ⅱ score between the two groups was statistically significant(P=0.001).According to the results of experience and drug sensitivity,carbapenems,piperacillin tazobactam,amikacin,cefoperazone sulbactam,piperacillin sulbactam and quinolones have become commonly used drugs to treat HAP caused by ESBL-Kp;Through multivariate Logistic regression analysis,APACHEⅡ score was found to be an independent risk factor for death of HAP patients caused by ESBL-Kp,P=0.003.Conclusion: The mortality of HAP infection caused by ESBL-Kp is high,and most of the patients are distributed in intensive care units of hospitals;Patients with more basic diseases and elderly patients are more likely to be infected with ESBL-Kp;in hospital.The resistance rate of ESBL-Kp to common antibiotics is higher,and the resistance rate of carbapenem is lower than other antibiotics.APACHEⅡ score is an independent risk factor for death of patients with HAP infection caused by ESBL-Kp,and the higher the score,the higher the risk of death.