Clinical Characteristics And Risk Factors Of The Transition From Carbapenem-sensitive Drug-resistant Klebsiella Pneumonia To CRKP

Objective The clinical characteristics and risk factors of the transition from carbapenem-sensitive drug-resistant klebsiella pneumonia to carbapenem-resistant klebsiella pneumonia(CRKP)are unknown.In order to understand the clinical symptoms of patients and analyze their clinical risks with carbapenem-sensitive drug-resistant klebsiella pneumonia transition to CRKP,we hope to provide a theoretical reference for reducing the CRKP,and therefore rationally use drugs and improving the prognosis of CRKP infections.Methods A retrospective study method was used to analyze the clinical data of 240 drug-resistant Klebsiella pneumoniae strains isolated from inpatients in the first college of clinical medical science China three gorges university hospital during the period of January 2018 to June 2019.These strains were divided into carbapenem resistant group and sensitive group according to the carbapenem antibiotics.By taking the sensitive group as the control group,the clinical characteristics of the two groups were analyzed to know the clinical symptoms and risks of carbapenem-sensitive drug-resistant klebsiella pneumonia transition to CRKP.Results The detection rate of CRKP is increasing in recent years.The isolation of strains in the CRKP group is mainly from intensive care unit,respiratory medicine,emergency internal medicine and the isolation of strains in the control group is mainly from general surgery,urinary surgery,neurosurgery department and the two groups of samples are mainly derived from sputum.The CRKP group is significantly higher in age(> 65 years old),history of underlying disease,hypertension,chronic obstructive pulmonary disease,chronic liver dysfunction,and chronic renal insufficiency.Compared with the control group,CRKP patients in the group have undergone invasive procedures such as central venous catheterization,tracheoscopy,mechanical ventilation,tracheostomy,indwelling gastric tube,indwelling urinary catheter,and indwelling drainage tube(including ventricle,maxillofacial region,neck,thoracic cavity,abdominal cavity,etc.)more.CRKP group is significantly more than the control group in combination medication,the use of penicillin before separation,the use of carbapenem antibiotics and the use of glucocorticoids before separation.Compared with the control group,CRKP group patients in white blood cell count,C-reactive protein and procalcitonin have significantly increased,and prealbumin and albumin have significantly decreased(p <0.05).Mortality,total length of stay and total cost of hospitalization in CRKP group is significantly higher than that of the control group.The multivariate logistic regression analysis shows that the history of basic disease(OR=15.723),the history of glucocorticoid use(OR=173.185),and the total length of hospital stay(OR=1.041)are all independent risk factors of the transition from carbapenem-sensitive drug-resistant klebsiella pneumonia to CRKP formation.Conclusion The detection rate of CRKP in the intensive care unit is high and the samples of CRKP group are mainly derived from sputum and blood.The isolates of control group are mainly derived from general surgery and the samples in control group are mainly from sputum and urine.If the carbapenem-sensitive drug-resistant klebsiella pneumoniae patients have a significant increase in white blood cell count,C-reactive protein and procalcitonin,the possibility of the transition from carbapenem-sensitive drug-resistant klebsiella pneumonia to CRKP should be noticed and recognized as early as possible.In order to tackle this problem,the production of CRKP should be reduced and the prognosis of CRKP patients should be improved by using less invasive procedures and using antibacterial drugs in clinical diagnosis and treatment rational.The history of the underlying disease,the history of glucocorticoid use and the total length of hospital stay are all independent risk factors of carbapenem-sensitive drug-resistant klebsiella pneumonia transition to CRKP.