Analysis Of Clinical Characteristics And Prognosis-related Risk Factors In Patients With Klebsiella Pneumoniae Bacteremia

Objective:By analyzing the clinical data and drug sensitivity data of adult inpatients with Klebsiella pneumoniae bacteremia in Beijing Hospital from 2014 to 2018,find out the clinical characteristics,drug sensitivity characteristics as well as change trends of Klebsiella pneumoniae bacteremia,analyze the risk factors of infection of carbapenem-resistant Klebsiella pneumoniae bacteremia;find out the short-term and long-term prognosis and risk factors of Klebsiella pneumoniae bacteremia patients.Methods:Collect the clinical data and drug susceptibility data of adult hospitalized patients with Klebsiella pneumoniae bacteremia in Beijing Hospital from 2014 to 2018,compare the differences in drug susceptibility results in different years,populations as well as clinical departments.Divide patients into cabapenem-resistant Carbapenem-Resistant Klebsiella pneumoniae(CR-KP)bacteremia group and Carbapenem-Sensitive Klebsiella pneumoniae(CS-KP)bacteremia group according to strain type,compare the basic conditions and course characteristics of the two groups of patients and analyze the risk factors of infected to CR-KP bacteremia.Conduct the patient follow-up at 4 and 48 weeks scince the break out of bacteremia to find out the survival status of the above patients,compare the basic conditions and course characteristics of the above patients in the survival group and the death group and analyze the risk factors associated with death at 4 and 48 weeks of bacteremia.Results:A total of 119 adult hospitalized patients affected in Klebsiella pneumoniae bacteremia from 2014 to 2018 in Beijing Hospital.Drug sensitivity analysis showed that the resistance of Klebsiella pneumoniae to aminoglycoside drugs was gradually increasing,and the resistance rates of gentamicin and amikacin increased from 11.8%and 5.9%in 2014 to 50.0%and 32.4%in 2018(P<0.05).The susceptibility of the other 13 antibacterial drugs did not show a trend with the year.The resistance rate of 119 strains of Klebsiella pneumoniae to carbapenem was 41.17%,and there were no statistically significant changes in resistance rate during 5 years.The separation rates of CR-KP in elderly patients(age ?65 years old)and non-elderly patients were 79.6%and 57.1%,respectively(P=0.011),and the separation rates in ICU wards and non-ICU wards were 51.0%and 15.7%,respectively(P<0.001),the separation rate between patients in emergency wards and non-emergency wards was 44.9%and 25.7%,respectively(P=0.0029).Among the 119 patients,107 patients with complete clinical data were selected for clinical study.There were 70 males and 37 females,aged from 27 to 95 years,with an average age of 69.70±16.43 years.The median number of days in hospital was 36 days.Through Logistic multivariate regression analysis,the independent risk factors for CR-KP bacteremia were:hospital-acquired Klebsiella pneumoniae bacteremia(OR=16.16,95%CI:1.71-163.35,P=0.016),anemia(OR=3.85,95%CI:1.04-14.23,P=0.043)and hypoalbuminemia(OR=18.52,95%CI:1.95-175.72,P=0.011).Among the 107 patients,35 died within 4 weeks after the occourance of bacteremia,and the mortality was 32.71%.The mortality of CR-KP bacteremia and CS-KP bacteremia within 4 weeks was 56.5%and 14.8%,respectively(P<0.001).Logistic multivariate regression analysis showed the independent risk factor for death of Klebsiella pneumoniae bacteremia patients within 4 weeks of bacteremia were:coronary heart disease at admission(OR=14.00,95%CI:1.32-148.43,P=0.028),usage of vasoactive drugs during the course of the disease(OR=6.74,95%CI:6.74-732.92,P<0.001)and septic shock during the course of the disease(OR=4.35,95%CI:4.35-178.23,P<0.001).Through follow-up to 62 patients with Klebsiella pneumoniae in 48 weeks after the occurrence of bacteremia,the reinfection rate of these patients was 40.32%within 48 weeks and the readmission rate was 48.38%.A total of 15 patients died within 4 to 48 weeks,and the mortality rate was 24.19%.The mortality of patients with CR-KP bacteremia and CS-KP bacteremia at week 4 to 48 was 52.6%and 11.6%(P=0.001),and the reinfection rates were 78.9%and 23.3%(P<0.001).Logistic multivariate regression analysis showed that CR-KP infection(OR=7.24,95%CI:1.76-29.75,P=0.006),septic shock occurred during the course of the disease(OR=18.05,95%CI:1.59-204.74,P=0.020)are independent risk factors for death of Klebsiella pneumoniae bacteremia patients within 4-48 weeks.Conclusions:1 Klebsiella pneumoniae has a high drug resistance rate,and the most sensitive antibacterial drug is the aminoglycoside,however,its drug resistance rate from Klebsiella is also increasing year by year.2 The separation rate of CR-KP is high.The separation rate of CR-KP in patients?65 years old is higher than patients<65 years old.The separation rate in emergency department and ICU are higher than those in non-emergency and non-ICU departments.3 Hospital-acquired Klebsiella pneumoniae bacteremia,anemia during the course of the disease,and hypoalbuminemia are independent risk factors for CR-KP bacteremia.4 The presence of coronary heart disease on admission,the use of vasoactive drugs during the course of the disease,and the appearance of septic shock during the course of disease are independent risk factors for death of Klebsiella pneumoniae bacteremia patients within 4 weeks of bacteremia.5 The occurrence of Klebsiella pneumoniae can produce long-term effects on patients.The occurrence of CR-KP strain infection is an independent risk factor for death of Klebsiella pneumoniae bacteremia patients at 4-48 weeks.