Relationships Between Antimicrobial Use And Antimicrobial Resistance In Klebsiella Pneumonia Of Inpatients,and Risk Factor For CRKP Acquisition Among ICU Patients

ObjectiveTo investigate the correlations between the antimicrobial use and antimicrobial resistance in K. pneumonia in our hospital, and based on the correlations to further identify risk factors, especially antibiotic use, for carbapenem-resistant Klebsiella pneumonia (CRKP) infection among intensive care unit (ICU) patients.Methods:The resistant rates of K. Pneumonia from 2009 to 2013 and the consumption of antimicrobial in our hospital were retrospectively analyzed. We analyzed data from January 1,2011 through June 30,2013 of ICU patients with an established of CRKP in our hospital. Using a case-control design, patients with CRKP infection were compared with those with carbapenem-susceptible Klebsiella pneumoniae (CSKP), matched with year of ICU admission and site of infection. The clinical outcomes and antibiotic treatments were analyzed.ResultsThe annual consumption of antimicrobial agents decreased year by year, and the annual consumption of extended-spectrum cephalosporins, fluoroquinolone and aminoglycosides decreased significantly (r<-0.72, p<0.05), but the annual consumption of carbapenems and compound preparations of β-lactamase inhibitors increased significantly (r>0.72, p<0.05). The correlation analysis showed that the use of extended-spectrum cephalosporins and the resistant rates of K. pneumonia to ceftazidime, ceftriaxone and cefepime was positively correlated (r>0.71, p<0.05), but we had not found the use of carbapenems was correlated with the resistant rates of K. pneumonia. Bivariable analysis showed that the age of patients, the number of antibiotic groups and the exposure to carbapenems (P<0.05) were associated with CRKP infection. Using multivariate analysis, adjusted for age, prior hospitalization, number of antibiotic groups and previous exposure to carbapenems, we identify previous carbapenems exposure (P<0.001) as an independent risk factor for CRKP infection. The mortality, the hospital length of stay and the ICU length of stay had no significant difference between CRKP and CSKP.ConclusionThese data suggest that the use of antimicrobial agents, especially the extended-spectrum cephalosporins is associated with the resistant rates of K. pneumonia, and the exposure to carbapenems is an independent risk factor for CRKP infection. So the clinical application of antimicrobial agents should be strictly and rationally controlled to slow down the development of bacterial resistance.