Clinical Distribution And Drug Resistance Analysis Of Klebsiella Pneumoniae In A Tertiary Hospital From 2017 To 2022

Background: Klebsiella pneumoniae(KPN)is a clinically important conditional pathogen,and its severe drug resistance poses a great challenge to the clinical treatment of this disease.Since the risk of KPN colonization and infection,as well as drug resistance,varies among different regions,time periods and clinical departments,it is important to understand the latest KPN infection and drug resistance in the hospital for the prevention and control of KPN.Objective: To analyze the clinical distribution and drug resistance of Klebsiella pneumoniae(KPN),and explore the correlation between repeated KPN admissions and drug resistance in Peking University Shenzhen Hospital.Methods: We retrospectively studied KPN-positive patients admitted to Peking University Shenzhen Hospital between August 2017 and March 2022.The clinically relevant data were collected,and the colonization and infection of KPN-positive patients and their clinical distribution were analyzed.The differences in drug resistance,including multiple drug resitence(MDR),carbapenem resistance and ultra broad-spectrumβ-lactamase-producing positivity,were compared between patients in the Intensive Care Unit(ICU)and other general departments,and the trends of KPN drug resitence in recent years was also analyszed.The correlation between repeacted admissions and drug resistance of Klebsiella pneumoniae in KPN-positive patients was explored by univariate and binary logistic regression analyses.Results: 1.The results showed that there were 1549 Klebsiella pneumoniae positive patients,of which 1480(95.60%)were diagnosed as infection and 69(4.40%)were identied as colonisation.The proportion of male patients among the patients with Klebsiella pneumoniae infection was significantly higher than that among the colonized patients(66.96% v.s 46.38%,p<0.001).The 3 departments with the highest positive rate of Klebsiella pneumoniae were neurosurgery(11.42%),respiratory and critical care medicine(8.30%)and neurology(7.40%),respectively,and ICU accounted for 4.40% of all positive cases.We found that the number of Klebsiella pneumoniae colonization cases in the whole hospital was increasing year by year.2.The result of the drug sensitivity tests showed that 69.68% of cases were sensitive,30.15% of cases were MDR postive,0.19% cases were XDR postive,19.88% patients presented CRKP positive,and 14.98% patients were ESBLs postive.By comparing the changes of drug resistance of Klebsiella pneumoniae between the whole hospital and ICU in recent years,we found that the positive rate of MDR showed a significant increasing trend.The rate of CRKP was significantly higher in ICU patients compared to other departments(21(30.43)vs 287(19.39),p=0.025).3.There were 91 repeated admissions who tested positive for Klebsiella pneumoniae,among them,35 patients were MDR postive on multiple admissions,43 patients showed sensitivity on multiple admissions,5 patients presented MDR followed by sensitivity,and7 patients showed sensitivity followed by MDR.In addition,6 patients showed either sensitivity or MDR during the same hospitalization.The positive rates of MDR,CRKP and ESBLs in patients tended to increase with the number of admissions.Compared to those non-readmission patients,repeated admissions(more than once)were older [66(54-76))vs 62(50-73),p=0.047],had a higher rate of MDR positivity [40(43.96)vs 427(29.39),p=0.003] and CRKP positivity [ 36(39.56)vs 272(18.66),p<0.001],and higher ESBLS positivity [22(24.18)vs 210(14.40),p=0.011].Binary logistic regression analysis showed that 34 CRKP positivity was a risk factor for repeated admissions in patients positive for Klebsiella pneumoniae [OR: 4.481(1.759-11.415),p=0.002].This study provides a reference value for understanding the clinical distribution and the drug resistance situation of Klebsiella pneumoniae in our hospital,which may improve the prevention and control of hospital-acquired infections,including thoes repeated admissions.Conclution: The total number of KPN infection cases has not changed significantly in recent years,but the number of colonized cases is on the rise,and the proportion of male patients among infected patients is significantly higher than among colonized patients.Neurosurgery had the highest risk of KPN infection in the whole hospital.The rate of MDR positivity for KPN was significantly higher in the whole hospital and in the ICU,and the rate of CRKP positivity was significantly higher in the ICU than in the whole hospital.CRKP positivity was a risk factor for multiple admissions of KPN-positive patients.