Analysis of risk factors for carbapenem-resistant <i>Klebsiella pneumoniae</i> detected in ICU patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Xin ¹ , SHEN Dandan ² , LIU Yinmei ¹ , QIAN Xiangling ¹ , YUAN Yinghua ² ,  YU Hong ¹

1. Department of Infection and Disease Control, Shanghai Tenth People's Hospital, Shanghai 200072, P. R. China;
2. Laboratory Microbiology Laboratory, Shanghai Tenth People's Hospital, Shanghai 200072, P. R. China;

Corresponding author：

YU Hong, Email: syyg66@126.com

Keywords：

Intensive care unit; Klebsiella pneumoniae; carbapenem resistance; risk factors; resistance genotypes

DOI：

10.7507/1671-6205.202103012

Video：

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Objective To explore the colonization of Klebsiella pneumoniae in the intensive care unit of our hospital and analyze the risk factors. Methods A total of 226 patients were actively screened in the surgical intensive care unit and neurosurgery intensive care unit from June to December 2020 in the hospital, and their clinical data were retrospectively analyzed. Results Totally, 87 strains of Klebsiella pneumoniae were screened out, 69 strains were carbapenem-resistant Klebsiella pneumoniae (CRKP), and the resistant genotype was mainly KPC genotype (79.6%). The resistance rates of meropenem were 75.0% and 77.4%, respectively. Age and pulmonary infection before admission are risk factors for CRKP colonization, while pulmonary infection before admission is an independent risk factor for CRKP colonization. Conclusions Both the CRKP colonization rate of patients and the rate of resistance to carbapenem antimicrobials are relatively high in the intensive care unit of our hospital. Pulmonary infection before admission is an independent risk factor for CRKP colonization.

Citation： WANG Xin, SHEN Dandan, LIU Yinmei, QIAN Xiangling, YUAN Yinghua, YU Hong. Analysis of risk factors for carbapenem-resistant Klebsiella pneumoniae detected in ICU patients. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(3): 158-161. doi: 10.7507/1671-6205.202103012 Copy

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6.	陈娜, 张峰波, 周鹏鹏, 等. 医院重症监护病区肺炎克雷伯菌对碳青霉烯类耐药性及其耐药基因分析. 中国感染与化疗杂志, 2020, 20(4): 423-429.
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12.	叶相如, 胡必杰, 周春妹, 等. 耐碳青霉烯类肺炎克雷伯菌感染与定植患者预后相关因素分析. 中华医院感染学杂志, 2015, 25(11): 2489-2491.
13.	夏粉芳, 郑春梅, 姜丹, 等. 神经外科重症监护室耐碳青霉烯类肠杆菌科细菌主动筛查结果. 中华医院感染学杂志, 2021, 31(22): 3427-3431.
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15.	朱桂红, 方英, 吕宇, 等. 重症监护病房碳青霉烯类耐药与敏感肺炎克雷伯菌感染患者经济损失及预后研究. 中国感染控制杂志, 2021, 20(5): 430-436.
16.	冯丽娜, 李从荣. 肺炎克雷伯菌碳青霉烯酶的研究进展. 医学综述, 2017, 23(2): 318-322+326.
17.	Chen L, Mathema B, Chavda KD, et al. Carbapenemase-producing Klebsiella pneumoniae: molecular and genetic decoding. Trends Microbiol, 2014, 22(12): 686-696.
18.	李三验, 陈建江, 吕清, 等. 耐碳青霉烯肺炎克雷伯菌耐药分析及耐药基因和多位点序列分析. 中国卫生检验杂志, 2020, 30(21): 2602-2604+2621.
19.	Lazarovitch T, Amity K, Coyle JR, et al. The complex epidemiology of carbapenem-resistant Enterobacter infections: a multicenter descriptive analysis. Infect Control Hosp Epidemiol, 2015, 36(11): 1283-1291.
20.	胡付品, 郭燕, 朱德妹, 等. 2018 年 CHINET 中国细菌耐药性监测. 中国感染与化疗杂志, 2020, 20(1): 1-10.
21.	杨敏, 丁奕博, 李柳琴, 等. 白族地区肺炎克雷伯菌临床分布及耐药分析. 中国呼吸与危重监护杂志, 2019, 18(1): 15-20.
22.	白雪冬, 毕丽岩. 医院获得性肺炎的危险因素和病原菌分布及耐药性分析. 中国呼吸与危重监护杂志, 2017, 16(1): 23-28.

1. Loon KV, Holt AFVI, Vos MC. A systematic review and meta-analyses of the clinical epidemiology of carbapenem-resistant Enterobacteriaceae. Antimicrob Agents Chemother, 2017, 62(1): e01730-17.
2. 喻华, 徐雪松, 李敏, 等. 肠杆菌目细菌碳青霉烯酶的实验室检测和临床报告规范专家共识. 中国感染与化疗杂志, 2020, 20(6): 671-680.
3. Zhang YW, Wang Q, Yin YY, et al. Epidemiology of carbapenem resistant Enterobacteriaceae infections: Report from the China CRE network. Antimicrob Agents Chemother, 2018, 62(2): e01882-17.
4. 胡付品, 郭燕, 朱德妹, 等. 2019 年 CHINET 三级医院细菌耐药监测. 中国感染与化疗杂志, 2020, 20(3): 233-243.
5. Tzouvelekis LS, Markogiannakis A, Psichogiou M, et al. Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clin Microbiol Rev, 2012, 25(4): 682-707.
6. 陈娜, 张峰波, 周鹏鹏, 等. 医院重症监护病区肺炎克雷伯菌对碳青霉烯类耐药性及其耐药基因分析. 中国感染与化疗杂志, 2020, 20(4): 423-429.
7. Baran I, Aksu N. Phenotypic and genotypic characteristics of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Turkey. Ann Clin Microbiol Antimicrob, 2016, 6(15): 20.
8. Munoz-Price LS, Poirel L, Bonomo RA, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis, 2013, 13(9): 785-796.
9. Gu D, Dong N, Zheng ZW, et al. A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study. Lancet Infect Dis, 2018, 18(1): 37-46.
10. Humphries RM, Yang S, Kim S, et al. Duodenoscope-related outbreak of a carbapenem-resistant Klebsiella pneumoniae identified using advanced molecular diagnostics. Clin Infect Dis, 2017, 65(7): 1159-1166.
11. 胡付品, 郭燕, 朱德妹, 等. 2020 年 CHINET 中国细菌耐药监测. 中国感染与化疗杂志, 2021, 21(4): 377-387.
12. 叶相如, 胡必杰, 周春妹, 等. 耐碳青霉烯类肺炎克雷伯菌感染与定植患者预后相关因素分析. 中华医院感染学杂志, 2015, 25(11): 2489-2491.
13. 夏粉芳, 郑春梅, 姜丹, 等. 神经外科重症监护室耐碳青霉烯类肠杆菌科细菌主动筛查结果. 中华医院感染学杂志, 2021, 31(22): 3427-3431.
14. Salsano A, Giacobbe DR, Sportelli E, et al. Risk factors for infections due to carbapenem-resistant Klebsiella pneumoniae after open heart surgery. Interact Cardiovasc Thorac Surg, 2016, 23(5): 762-768.
15. 朱桂红, 方英, 吕宇, 等. 重症监护病房碳青霉烯类耐药与敏感肺炎克雷伯菌感染患者经济损失及预后研究. 中国感染控制杂志, 2021, 20(5): 430-436.
16. 冯丽娜, 李从荣. 肺炎克雷伯菌碳青霉烯酶的研究进展. 医学综述, 2017, 23(2): 318-322+326.
17. Chen L, Mathema B, Chavda KD, et al. Carbapenemase-producing Klebsiella pneumoniae: molecular and genetic decoding. Trends Microbiol, 2014, 22(12): 686-696.
18. 李三验, 陈建江, 吕清, 等. 耐碳青霉烯肺炎克雷伯菌耐药分析及耐药基因和多位点序列分析. 中国卫生检验杂志, 2020, 30(21): 2602-2604+2621.
19. Lazarovitch T, Amity K, Coyle JR, et al. The complex epidemiology of carbapenem-resistant Enterobacter infections: a multicenter descriptive analysis. Infect Control Hosp Epidemiol, 2015, 36(11): 1283-1291.
20. 胡付品, 郭燕, 朱德妹, 等. 2018 年 CHINET 中国细菌耐药性监测. 中国感染与化疗杂志, 2020, 20(1): 1-10.
21. 杨敏, 丁奕博, 李柳琴, 等. 白族地区肺炎克雷伯菌临床分布及耐药分析. 中国呼吸与危重监护杂志, 2019, 18(1): 15-20.
22. 白雪冬, 毕丽岩. 医院获得性肺炎的危险因素和病原菌分布及耐药性分析. 中国呼吸与危重监护杂志, 2017, 16(1): 23-28.

Chinese Journal of Respiratory and Critical Care Medicine

Analysis of risk factors for carbapenem-resistant Klebsiella pneumoniae detected in ICU patients

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