Five-year Change Of Resistance Surveillance And Risk Factors For Infection And Mortality Of Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infection

Objective: The aim of the present study is to analyze the distribution,resistance surveillance,incidence and mortality of Carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection(BSI)in the Second Hospital of Hebei Medical University from 2014 to the first half of 2019,and then identify the risk factors for infection and mortality of CRKP BSI.Methods:Whonet 5.7 was used to retrospectively analyze the resistance surveillance of Klebsiella pneumoniae(KP)isolated from blood samples in the Second Hospital of Hebei Medical University from 2014 to the first half of 2019.164 patients with CRKP and 328 with carbapenem-susceptive Klebsiella pneumoniae(CSKP)BSI were categorized as the case group and control group to identify risk factors for CRKP infection and mortality by univariable analysis and multivariable logistic-regression analysis using SPSS 22.0.Results: 1.The prevalence of CRKP BSI increased significantly,with the percentage of KP in BSI increasing from 7% to 12% from 2014 to 2019 with a concomitant resistance to meropenem increasing from 16.7% to 41.8%.2.The resistance rate of KP to all kinds of antimicrobials was on the rise,and the resistance rate of CRKP is generally higher than that of CSKP.No strain was resistant to tigecycline or polymyxin.3.KP bloodstream infections were mainly distributed in ICU,Respiratory Medicine and Hematology.Among them,CRKP accounted for 64.5%(71/110)in ICU,while CSKP accounted for 72.6%(69/95)in Hematology.4.The mortality in CRKP group was 43.9%(72/164),while 14.9%(49/328)in CSKP group(P < 0.001).5.KP detection in other sites(P=0.036,OR 1.964),blood purification(P=0.018,OR 3.326),bronchoscopy(P=0.011,OR 5.423),surgery(P=0.001,OR 3.084),carbapenem use(P=0.001,OR 3.395),tigecycline use(P=0.006,OR 4.595)were risk factors for CRKP BSI.6.Previous hospitalization(P = 0.048,OR 2.755),long hospitalization(P = 0.003,OR 1.035),bone marrow puncture(P = 0.037,OR3.856),use of ?-lactamase inhibitor(P = 0.005,OR 3.890)were independent predictors of mortality of CRKP BSI.Conclusion:The prevalence and mortality of CRKP BSI have increased year by year.Timely treatment of KP infections in other sites,strengthening the hospital infection control of blood purification,bronchoscopy and surgery,controlling the use of carbapenem and tigecycline,may help prevent CRKP BSI.More preventative hospital resources are needed for severely ill patients with prolonged hospitalizations and intensive care.