Research On Infection Status And Related Factors Of Carbapenem-resistant Klebsiella Pneumonia In ICU

Objective:To study the infection status and the related factors of CarbapenemResistant Klebsiella Pneumonia(CRKP)patients in a third-level hospital from October 2014 to September 2019 in the Intensive Care Unit(ICU);explore the correlation between APACHE Ⅱ score,serological indicators and CRKP infection and research the mortality and independent risk factors of CRKP infection patients.These results are considered to attract the attention of medical staff,strengthen infection prevention and control measures,and provide prevention and control of clinical infection Scientific basis.Methods:A retrospective survey of 650 patients with ICU Klebsiella pneumoniae infection in a tertiary hospital from October 2014 to September 2019.Designed by the team members and reviewed by the expert group,the "Klebsiella pneumoniae infection patient questionnaire" was prepared to investigate the patient’s basic information,infection status,underlying disease,invasive operation,antibacterial drug use,serological indicators.Klebsiella pneumoniae patients were divided into drug resistance group(99 cases)and sensitive group(551 cases),according to whether they were resistant to carbapenem antibacterial drugs,namely CRKP group and CSKP(Carbapenem-Susceptible Klebsiella Pneumonia,Carbapenem-sensitive Klebsiella pneumonia)group.Analyze the demographic characteristics,source of infection specimens,and sensitivity of commonly-used antibacterial drugs in patients with CRKP infection;perform univariate analysis on the risk factors of CRKP infection,and use Logistic regression to analyze independent risk factors for CRKP infection;study the APACHEII scores,differences in serological indicators;study the differences in mortality between the two groups of patients,and use Logistic regression to analyze the independent risk factors of death in CRKP group.All data were statistically analyzed using SPSS 23.0 software.Results:1.Among the 650 patients with Klebsiella pneumoniae infection that met the standard,the average age of the CRKP group was(72.80±13.53)years,and the average age of the CSKP group was(63.34±14.98)years.(χ2=2.908,P=0.036),The difference was statistically significant.There are 74 patients in the CRKP group≥65 years old,accounting for 74.74%of the CRKP group.The results show that the age ≥65 years old is at risk of contracting CRKP.2.There was no significant difference between CRKP group and CSKP group in gender(χ2=0.952,P=0.328).3.Of the 650 specimens that met the criteria,the top three sources of clinical specimens for Klebsiella pneumoniae infection were sputum and alveolar lavage fluid(333 cases,a composition ratio of 51.23%),urine(139 cases,Composition ratio 21.38%),pleural and ascites drainage(105 cases,composition ratio 16.15%).These three types of specimens accounted for 88.76%of the total specimens,which were the main component of specimen types.In the CRKP group,sputum and alveolar lavage fluid were 47 cases,accounting for 47.48%,and urine were 25 times,accounting for 25.25%.4.Drug sensitivity tests were conducted on 21 common antibacterial drugs.The drug resistance rates of CRKP patients were piperacillin(87.98%),meropenem(76.81%),and aztreonam(75.90%).The high ones were tigecycline(46.89%),cefoperazone and sulbactam(44.80%),and piperacillin tazobactam(43.82%).5.The univariate analysis of risk factors for CRKP infection were as follows:age≥65 years,diabetes,bronchiectasis,central venous catheterization for ≥7 days,use of invasive ventilator,tracheotomy and intubation,urinary tract intubation for ≥7 days,and use of antibacterial drugs for>On day 14,surgery,heart failure,renal impairment,high APACHE Ⅱ score,elevated serum procalcitonin levels,elevated plasma aminoterminal brain natriuretic peptide levels,elevated serum creatinine levels,and nosocomial infections.6.Independent risk factors for CRKP infection were analyzed by Logistic regression:invasive ventilator use(OR=2.904,95%CI:1.342 to 3.129),heart failure(OR=4.328,95%CI:3.285 to 4.217),and renal function impairment(OR=2.173,95%CI:1.854～3.091),high APACHE Ⅱ score(OR=4.521,95%CI:2.783～5.621),elevated serum procalcitonin level(OR=2.976,95%CI:1.769～3.321),plasma amino-terminal brain natriuretic peptide levels increased(OR=3.803,95%CI:2.595 to 3.231),serum creatinine levels(OR=2.432,95%CI:1.770 to 3.218),antibacterial use(OR=3.653,95%CI:2.321～3.990).7.Compare the average value of APACHE Ⅱ score,serum procalcitonin,plasma amino-terminal brain natriuretic peptide,and serum creatinine during the infection in the CRKP group and the CSKP group,the results show that each data of the CRKP group was higher than the CSKP group.All were statistically significant(P<0.05).For patients with APACHE Ⅱ score of(24.76±6.28)points,serum procalcitonin was(28.70±3.24)ng/ml,plasma amino-terminal brain natriuretic peptide was(3622.85±352.80)pg/ml,and serum creatinine(138.90±45.38))Umol/L,there is a risk of CRKP infection.8.Among the 650 patients with Klebsiella pneumoniae infection that met the criteria,there were 99 in the CRKP group,27 deaths,a 28.28%mortality rate,551 in the CSKP group,57 deaths,and a mortality rate of 10.34%.The mortality rate in the CSKP group was 17.94%higher.Comparison,between the two groups(χ2=21.370 P<0.001),was statistically significant.9.Through the Logistic regression analysis,the results showed that the independent risk factors for death in the CRKP group were>65 years of age(OR=3.872,95%CI:2.667 to 4.246),and high APACHE Ⅱ score(OR=5.864,95%Cl:4.783 to 6.621),elevated serum procalcitonin levels(OR=6.321,95%Cl:5.769 to 7.326),elevated plasma amino-terminal brain natriuretic peptide levels(OR=8.804,95%CI:6.595 to 9.236),serum creatinine The level increased(OR=2.761,95%CI:1.770～3.218).Conclusion:1.Among patients with Klebsiella pneumoniae infections in ICU,the elderly are the main patients,and those aged 65 years or older are at the risk of infecting CRKP.2.The most prone site of CRKP infection is the lower respiratory tract,followed by the urinary system.3.Compound preparations containing lactamase inhibitors,penicillin piperacillin and tazobactam,and third-generation cephalosporin cefoperazone and sulbactam,can be used as a preferred choice for clinical treatment of CRKP.4.Invasive ventilator use,heart failure,renal impairment,high APACHE Ⅱ score,elevated serum procalcitonin levels,elevated plasma amino-terminal brain natriuretic peptide levels,elevated serum creatinine levels,and use of antibacterial drugs are considered as CRKP independent risk factors.5.When the patient’s APACHE Ⅱ score reached(24.76± 6.28)points,the serum procalcitonin was(28.70±3.24)ng/ml,the plasma amino-terminal brain natriuretic peptide was(3622.85±352.80)pg/ml,and the serum creatinine(138.90±45.38))umol/L,there is a risk of CRKP infection.6.The mortality rate of CRKP group was 17.94%higher than that of CSKP group.The independent risk factors for death of CRKP were as follows:patients aged ≥65 years,with high APACHE Ⅱ score,elevated serum procalcitonin levels,elevated plasma amino-terminal brain natriuretic peptide levels,and elevated serum creatinine levels.7.Observing the APACHE Ⅱ score,serum procalcitonin level,plasma aminoterminal brain natriuretic peptide level,and serum creatinine level are helpful to judge CRKP infection and prognosis.