Clinical Distribution And Drug Sensitivity Analysis Of Klebsiella Pneumoniae Blood Flow Infection

OBJECTIVE:To analyze and evaluate the clinical data of blood culture positive Klebsiella pneumoniae from Zibo maternal and child health care hospital from 2013 to 2018,so as to understand the main distribution departments and drug sensitivity characteristics,and provide laboratory basis for clinical rational application of antibiotics.METHODS:The electronic case data of 140 patients with blood flow infection caused by Klebsiella pneumoniae from May 2013 to may 2018 in Zibo maternal and child health hospital were retrospectively investigated,and the clinical distribution and drug sensitivity results were analyzed.Kirby-Baue method was used for drug sensitivity test and SPSS 16.0 software was used for statistical analysis.Results:1.There were 140 blood culture positive Klebsiella pneumoniae strains.The top five clinical distribution departments were infectious department,respiratory department,oncology department,digestive department and geriatrics department.The constituent ratios were 24.3 %,20.0 %,14.3 %,10.0 % and 7.1 %.respectively.2.The top five antibiotics with the highest resistance rate were piperacillin,ampicillin/sulbactam,cefazolin,compound sulfamethoxazole and cefepime.3.The top five antibiotics with the highest sensitivity rate were meropenem,amikacin,imipenem,cefoperazone/sulbactam and piperacillin/tazobactam.4.From 2014 to 2018,the susceptibility rates of blood culture positive Klebsiella pneumoniae to ampicillin sulbactam and compound sulfamethoxazole remained stable,with an average of 41.3 % and 51.4 %,respectively.The susceptibility rates to cefoperazone sulbactam were good,with an average of 79.3 %,with a downward trend,but there was no significant difference(P < 0.05).The sensitivity rates of cefazolin,cefuroxime,ceftazidime,ceftriaxone,cefotaxime,cefepime and aztreonam were not high,with an average of 19.29 %,42.9 %,46.4 %,54.3 %,58.6 %,52.9 % and 61.4 %,respectively.There was a decreasing trend year by year,but there was no significant difference(P < 0.05).Good,with an average of 72.9 %,increased from 72.7 % in 2014 to 85.7 % in 2015,and decreased year by year to 66.7 % in 2018;Good sensitivity rates to ciprofloxacin and levofloxacin were 58.6 % and 63.6 % respectively,declining year by year from 2014 to 2016,and stable sensitivity rates to meropenem and amikacin from 2016 to 2018;Good sensitivity rates to ciprofloxacin and levofloxacin were 58.6 % and 63.6 % respectively.Imipenem had the highest sensitivity and remained stable,with an average of 96.43 %,96.00 % and 92.86 %,respectively.Seven strains of imipenem and meropenem were gradually resistant to imipenem and meropenem.5.The detection rate of Klebsiella pneumoniae producing ESBLs increased year by year,but there was no significant difference(P < 0.05).Klebsiella pneumoniae producing ESBLs and non-producing ESBLs were highly sensitive to imipenem and meropenem,but less sensitive to piperacillin.ESBLs-producing strains were only more than 50 % sensitive to piperacillin/tazobactam,amikacin,ciprofloxacin and levofloxacin,but less sensitive to other antimicrobial agents.ESBLs-producing strains were more sensitive to antimicrobial agents than 80 %.The susceptibility rates of ESBLs-producing strains to other commonly used antibiotics except imipenem,meropenem,piperacillin/tazobactam,amikacin,ciprofloxacin and levofloxacin were higher than those of non-ESBLs-producing strains(P < 0.05).6.There were 7 strains of Klebsiella pneumoniae producing carbapenemase,and the detection rate remained stable.Klebsiella pneumoniae resistant to carbapenemase was resistant to most antibiotics and sensitive to tegacycline.CONCLUSION:1.The patients with bloodstream infection caused by Klebsiella pneumoniae are mainly in the infectious department,respiratory department and oncology department.2.The top five antibiotics with the highest sensitivity were meropenem,amikacin,imipenem,cefoperazone/sulbactam and piperacillin/tazobactam.3.From 2014 to 2018,the detection rate of ESBLs-producing Klebsiella pneumoniae was increasing year by year.ESBLs-producing strains were sensitive only to piperacillin/tazobactam,amikacin,ciprofloxacin and levofloxacin,and to other antimicrobial agents.The sensitivity of ESBLs producing strains to imipenem,meropenem,piperacillin / tazobactam,amikacin,ciprofloxacin,levofloxacin and other commonly used antibiotics was higher than that of non ESBLs producing strains.4.During 2013-2018,there were 7 Klebsiella pneumoniae strains producing carbapenem,the detection rate remained stable;these strains were resistant to most of the antibiotics,and sensitive to tegacyclin..