[Analysis of related factors of carbapenem resistant Klebsiella pneumoniae infection in patients with artificial airway].

Abstract

OBJECTIVE:

To analyze the clinical characteristics and related influencing factors of carbapenem resistant Klebsiella pneumoniae (CRKP) in patients with artificial airway and mechanical ventilation in intensive care unit (ICU), and provide theoretical basis for clinical prevention of Klebsiella pneumoniae infection.

METHODS:

The clinical data of patients with pulmonary infection of Klebsiella pneumoniae in ICU of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2016 to December 2019 were collected. Compared CRKP pneumonia patients (study group) with carbapenem antibiotic sensitive Klebsiella pneumoniae (CSKP) pneumonia patients (control group), the clinical characteristics [gender, age, acute physiology and chronic health evaluation II (APACHE II), duration of mechanical ventilation, proportion of patients with mechanical ventilation > 10 days, use of antibiotics before detection of Klebsiella pneumoniae, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), albumin, bedridden for more than 1 month before admission, 28-day mortality] were analyzed. The drug resistance rates of Klebsiella pneumoniae in both groups and difference of drug resistance rate of Klebsiella pneumoniae to different antibiotics from 2016 to 2019 were compared. The risk factors of CRKP infection were analyzed by multivariate Logistic regression, and the related drug resistance genes were detected.

RESULTS:

Compared with the control group, the study group was older [years old: 81.5 (72.0, 86.0) vs. 78.0 (71.0, 80.5)], APACHE II [point: 25.00 (20.00, 34.00) vs. 19.00 (14.00, 23.25)] and proportion of patients with mechanical ventilation > 10 days [63.2% (182/288) vs. 12.8% (10/78)], the use of β-lactamase inhibitor antibiotics before detection of Klebsiella pneumoniae [75.69% (218/288) vs. 30.77% (24/78)], the use of carbapenems [79.86% (230/288) vs. 41.03% (32/78)], the use of more than two kinds of antibiotics [80.90% (233/288) vs. 29.49% (23/78)], proportion of patients staying in bed for more than 1 month before admission [40.97% (118/288) vs. 11.54% (9/78)] and WBC [×109/L: 9.72 (6.41, 14.69) vs. 7.57 (5.84, 12.61)], CRP [mg/L: 74.45 (36.30, 158.88) vs. 39.22 (13.68, 92.51)], PCT [μg/L: 3.87 (0.82, 19.24) vs. 0.51 (0.25, 5.71)], 28-day mortality [21.5% (62/288) vs. 10.3% (8/78)] were higher, albumin [g/L: 24.1 (18.3, 28.6) vs. 30.1 (23.8, 35.1)] was lower, duration of mechanical ventilation [days: 16.5 (9.0, 19.0) vs. 7.0 (5.0, 10.0)] was longer, the proportion of patients with chronic obstructive pulmonary disease [COPD: 35.76% (103/288) vs. 11.54% (9/78)], malignant tumor [18.06% (52/288) vs. 5.13% (4/78)], renal failure [31.94% (92/288) vs. 11.54% (9/78)], shock [51.74% (149/288) vs. 19.23% (15/78)] were higher, and the differences were statistically significant (all P < 0.05). The drug resistance rates of Klebsiella pneumoniae to aztreonam, piperacillin/tazobactam, imipenem and ciprofloxacin were statistically significant (all P < 0.05); the drug resistance rates of Klebsiella pneumoniae to aztreonam and piperacillin/tazobactam were the highest in 2019 (88.17% and 86.02%, respectively), and the lowest in 2016 (70.65% and 57.61%, respectively). The drug resistance rate to imipenem was the highest in 2018 (86.32%), the lowest in 2016 (59.78%); the resistance rate to ciprofloxacin was the highest in 2016 (76.09%), and the lowest in 2018 (53.68%). The resistance rates of ceftetan, amikacin, piperacillin/tazobactam, ceftazidime, ceftriaxone and gentamicin in the study group were significantly higher than those in the control group (82.99% vs. 62.82%, 49.31% vs. 17.95%, 75.69% vs. 60.26%, 81.25% vs. 64.10%, 80.21% vs. 58.97%, 91.32% vs. 60.26%, all P < 0.05). Logistic regression analysis showed that COPD, severe hypoproteinemia, mechanical ventilation time > 10 days and the use of carbapenem antibiotics before detection of Klebsiella pneumoniae were independent risk factors of CRKP infection. Gene detection showed that there were TEM, KPC, AmpC, AAC(3)-II, ant(3")-I, qnrS and other drug resistance genes in CRKP. The detection rate of TEM was the highest (74.00%), and qnrA was the lowest (6.67%).

CONCLUSIONS:

The occurrence of CRKP in ICU patients with artificial airway and mechanical ventilation is related to many factors. It is necessary to shorten the mechanical ventilation time, avoid the nonstandard use of carbapenem antibiotics, and improve the serum albumin level, so as to reduce the incidence of CRKP pneumonia and improve the prognosis of patients.

• Authors: Weishuai Bian, Wei Chen, Xuyun Gu, Suozhu Wang, Yang Liu, Guomin Zhao, Yujun Qin
• Journal: Zhonghua wei zhong bing ji jiu yi xue (Zhonghua Wei Zhong Bing Ji Jiu Yi Xue) Vol. 32 Issue 11 Pg. 1324-1330 (Nov 2020) ISSN: 2095-4352 [Print] China
• PMID: 33463491 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Carbapenems
• Imipenem

Topics

• Anti-Bacterial Agents (pharmacology, therapeutic use)
• Carbapenems (therapeutic use)
• Drug Resistance, Bacterial
• Humans
• Imipenem
• Klebsiella Infections (drug therapy, epidemiology)
• Klebsiella pneumoniae
• Risk Factors