Risk Factors And Prognosis Attributable To Different Klebsiella Pneumoniae Susceptibility Patterns Lower Respiratory Tract Infection In Intensive Care Unit

Purpose: To retrospectively study the lower respiratory tract infection of Klebsiella pneumonia(KP)in ICU patients of the Second Affiliated Hospital of Hainan Medical University,to analyze the risk factors of Klebsiella pneumoniae infection and death in different susceptibility patterns,so as to obtain clinical experience to guide clinical treatment and Improve patient survival rate.Methods: Bacterial culture results of sputum and alveolar lavage fluid of inpatient ICU patients in the Second Affiliated Hospital of Hainan Medical College from January 1,2010 to December 31,2019 were collected to screen out clinical data of patients infected with KP.A total of 362 subjects were included to study,aged65.03±16.93 years old.Among them,there were 212 cases in the sensitive Klebsiella pneumonia(MSKP)group,111 cases in the broad-spectrum cephalosporin-resistant but carbapenem-sensitive Klebsiella pneumonia(ESCR-CS-KP)group,and 39 cases in the carbapenem-resistant Klebsiella pneumonia(CRKP)group.Statistical analysis,based on patients’ basic information,underlying diseases,concomitant diseases,invasive treatment,antibiotic use before and after diagnosis was used to determine the infected rates and risk factors of prognosis in different susceptibility patterns of Klebsiella pneumonia infection.Results:(1)The dependent variable MSKP group was used as the reference category:univariate analysis showed that the infection rate of ESCR-CS-KP between the groups was statistically different(P<0.05)in the factors of age,ICU duration,coronary heart disease,chronic kidney disease,liver insufficiency,major trauma,tracheal intubation,indwelling drainage tube,recent surgical history.Multivariate logistic regression analysis showed that ICU duration [OR=1.035,95%CI=1.011～1.059,P=0.004],chronic Kidney disease [OR=4.198,95%CI=1.729-10.194,P=0.002]is an independent risk factor for ESCR-CS-KP infection.Univariate analysis showed that: the CRKP infection rate between groups was statistically different(P<0.05)in factors of age,ICU duration,APACHE II score at ICU admission,coronary heart disease,CDPD,recent surgical history.multivariate Logistic regression analysis showed : ICU hospitalization days [OR=1.056,95%CI=1.027～1.086,P<0.001],age[OR=1.033,95%CI=1.003～1.064,P=0.032] is independent risk factor for CRKP infection.(2)Analysis of the prognosis of Klebsiella pneumoniae infection in different susceptibility patterns: the univariate analysis of the MSKP group presented that the mortality rate between the groups was statistically different(P<0.05)in factors of the total number of days of hospitalization,heart failure,respiratory failure,renal insufficiency,shock,tracheal intubation,invasive ventilator,recent history of surgery,deep venous catheterization,and use of piperacillin and tazobactam after diagnosis.Multivariate logistic regression analysis showed: respiratory failure [OR=2.251,95%CI=1.017 ～ 4.983,P=0.045],renal insufficiency [OR=5.259,95%CI=2.154 ～ 12.839,P<0.001],recent operation history [OR=4.425,95%CI=1.740 ～11.256,P=0.002] is an independent risk factor for death in patients with MSKP infection,the total number of days in hospital [OR=0.941,95%CI=0.914 ～ 0.968,P<0.001],piperacillin and tazobactam after diagnosis [OR=0.355,95%CI=0.140 ～ 0.902,P=0.029] is a protective factor for survival;in the single factor analysis of ESCR-CS-KP group,the total days of hospitalization,chronic kidney disease,renal insufficiency,liver insufficiency,In terms of shock,tracheal intubation,deep venous catheterization and other factors,the mortality between the groups was statistically different(P<0.05).Multivariate Logistic regression analysis showed: shock [OR=10.294,95%CI=3.228～32.822,P<0.001],deep venous catheterization [OR=5.731,95%CI=1.087-30.219,P=0.040] is an independent risk factor for death in patients with ESCR-CS-KP infection,the total number of days in hospital [OR=0.942,95 %CI=0.908 ～ 0.978,P=0.002] is a protective factor for survival;in the CRKP group,in the univariate analysis,the mortality rate between the groups was all factors such as liver insufficiency,shock,invasive ventilator,and tracheal intubation.There are statistical differences(P<0.05).The above factors are not independent risk factors for death in patients with CRKP infection,but the mortality rate of CRKP group was significantly higher than that of MSKP group and ESCR-CS-KP group,and the difference was statistically significant.(P<0.05).Conclusions:(1)Longer days of ICU hospitalization will increase the risk of ESCR-CS-KP or CRKP infection.Patients with chronic kidney disease will increase the risk of ESCR-CS-KP infection,and older patients are more susceptible to CRKP infection.(2)Patients with MSKP infection with respiratory failure,renal insufficiency,operation history in recently will increase the mortality rate,but the timely use of piperacillin and tazobactam may increase the survival rate of patients,and the prognosis of patients with longer hospital stays is better.patients with ESCR-CS-KP infection with shock and deep venous catheterization will increase the mortality rate,but patients with longer hospital stays have a better prognosis;patients with CRKP infection can increase the mortality rate.