Study On Infection Factors Of Klebsiella Pneumoniae And Recommendation Of Clinical Medication Scheme

OBJECTIVE: Through retrospective analysis of the clinical characteristics of patients with carbapenem-resistant Klebsiella pneumonia(CRKP)in the People’s Hospital of Yichun City,to find the clinical cause of the patient’s infection with CRKP.Through induction experiments,genetic testing and drug combination experiments,etc.,provide references for the use of CRKP in clinical treatment,so as to achieve the purpose of reducing the infection rate of hospital CRKP,improving the treatment effect and reducing the abuse of antibiotics.Methods: Through retrospective analysis of the medical records of patients who were hospitalized in Yichun People’s Hospital from 2018 to 2019 and had CRKP infection and colonization,the factors of CRKP infection/colonization patients and death/non-death patients after infection were statistically analyzed.The gradient plate method was used to induce clinically fully sensitive Klebsiella pneumoniae to different degrees of resistance to six antibiotics,and to find out the laws of incidental sensitivity and cross-resistance in the treatment of CRKP.The broth double dilution method and the micro checkerboard method were used for joint experiments to calculate the partial inhibitory concentration index(FICI)and judge the joint effect.The PCR method was used to amplify the corresponding drug resistance genes,and the products were compared and analyzed.Results: A total of 48 CRKP patients were infected/colonized from 2018 to 2019,including 26 infected patients and 22 colonized patients.After the infection,16 cases died and 10 cases recovered.An independent sample T test found that 10 factors such as age,invasive ventilation,and admission to the ICU were risk factors for the patient’s CRKP infection,while three clinical manifestations such as pneumonia,immunosuppressant and steroid use were the death factors.In the process of inducing bacterial resistance,it was found that the resistance rate was: doxycycline(DOX)>piperacillin,tazobactam(TZP)> amikacin(AMK)> cefoperazone and sulbactam(SCF))> Imipenem(IMI)> Meropenem(MER).As the induced concentration of resistant strains increases,there will be varying degrees of incidental sensitivity to amikacin or doxycycline,and cross-resistance to other drugs will appear at the same time.In the genetic testing,it was found that all 7 clinical strains produced KPC(Klebsiella pneumoniae carbapenemase)enzyme,and the 6 induced strains CRKP also produced KPC enzyme.Drug combination experiments found that the synergy rate of doxycycline combined with amikacin reached 100%,doxycycline or amikacin combined with imipenem,the effective rate reached 100%,followed by doxycycline combined with piperacillin Tazobactam has an effective rate of 83%.However,among all synergistic effects,only doxycycline combined with piperacillin and tazobactam can reduce the minimum inhibitory concentration(MIC)of piperacillin and tazobactam below the sensitive value(≤32 μg/m L),The combined effect is the best.Conclusion: Older age and admission to the ICU are all risk factors for patients with CRKP infection.In the course of clinical medication,antibiotics can be used alternately according to the principle of incidental sensitivity in response to drug resistance.And the clinical recommended medication is: doxycycline combined with piperacillin and tazobactam.