Clinical characteristics and drug resistance of <i>Klebsiella pneumoniae</i> in patients with nosocomial and community infections in Quanzhou, China_Chinese Journal of Evidence-Based Medicine

Authors：

 CHEN Xiarong , LIN Liling , WU Yihai , ZHANG Huaping , ZENG Xiuyu , QIU Xiulan , WENG Yueping

Department of Hospital-Acquired Infection Control, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, P.R.China;

Corresponding author：

CHEN Xiarong, Email: fjmucxr@126.com

Keywords：

Klebsiella pneumonia; Extended-spectrum beta-lactamase (ESBL); Nosocomial infection; Community infection; Distribution; Drug resistance rate

DOI：

10.7507/1672-2531.201812098

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Objective To compare the clinical characteristics of patients with nosocomial and community infections with extended-spectrum beta-lactamase-containing Klebsiella pneumoniae (ESBL-KP) and non-ESBL-KP so as to improve clinical diagnosis and treatment outcomes.Methods This retrospective study determined the clinical features of patients with nosocomial and community infections with KP who were admitted to our hospital from January 1^st, 2017 to June 30^th, 2018. The chi-square test or Fisher's exact probability method were used to compare different groups.Results We identified 334 strains of KP, and 83 (24.9%) of them strains were EBSL-KP. The percentages of ESBL-KP infections among those with nosocomial and community infections were similar (31.25% vs. 22.27%, χ²=2.955, P=0.086). Significantly more females than males had ESBL-KP infections (32.32 vs. 21.70%, χ²=4.208, P=0.040). The percentages of ESBL-KP infections were similar among <18 years-old group, 18 to 45 years-old group, 45 to 60 years-old group, and ≥60 years-old group. The three major locations of KP infections were the lower respiratory tract, urinary tract, and bloodstream (bacteremia). Among nosocomial KP infections, there were no significant differences in the percentages of ESBL-KP infections at different sites, nor in the hospital departments where patients were treated; among community KP infections, there were significant differences in the percentages of ESBLs-KP infections at different sites, and in the hospital departments where patients were treated. For community KP infections, the two most common infection sites were the urinary tract (37.74%) and the skin and soft tissue (30.77%), and most patients were treated in the urology department (40.00%) and respiratory medicine department (38.10%). ESBL-KP isolates had greater resistance than non-EBSL-KP isolates to 16 tested antibiotics (P<0.05). There were no statistically significant differences in the percentages of nosocomial infections and community infections among those with ESBL-KP and among those with non-ESBL-KP (P>0.05).Conclusions Our population have high rates of nosocomial and community KP infections and of infections with ESBL-KP. It is necessary to strengthen the management and clinical use of antibiotics and to provide real-time surveillance of KP infections, especially for patients with ESBL-KP infections. Increased vigilance is required for KP infections of females and community KP infections to improve control of nosocomial infections and reduce the prevalence of cross-infections.

Citation： CHEN Xiarong, LIN Liling, WU Yihai, ZHANG Huaping, ZENG Xiuyu, QIU Xiulan, WENG Yueping. Clinical characteristics and drug resistance of Klebsiella pneumoniae in patients with nosocomial and community infections in Quanzhou, China. Chinese Journal of Evidence-Based Medicine, 2019, 19(9): 1018-1023. doi: 10.7507/1672-2531.201812098 Copy

1.	张前进, 孙德明, 谢志强, 等. 肺炎克雷伯菌的临床感染特点及耐药性分析. 中华医院感染学杂志, 2014, 24(13): 3137-3138, 3141.
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3.	季淑娟, 顾怡明, 谭文涛, 等. 中国部分地区大肠埃希菌和肺炎克雷伯菌超广谱 β 内酰胺酶基因型研究. 中华检验医学杂志, 2004, 27(9): 590-593.
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10.	Meier S, Weber R, Zbinden R, et al. Extended-spectrum beta-lactamase-producing gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy. Infection, 2011, 39(4): 333-340.
11.	黄艳飞, 张嘉琦. ESBL 阳性肺炎克雷伯菌所致肺炎临床特点和耐药性分析. 标记免疫分析与临床, 2018, 25(7): 929-934.
12.	吴雪花, 陈林俊, 徐华. 外科手术部位感染常见病原菌及其耐药性分析. 现代实用医学, 2014, 26(10): 1308-1309.
13.	马利. 某院大肠埃希菌与肺炎克雷伯菌感染的临床特征及耐药分析. 临床医学研究与实践, 2018, 3(11): 99-100, 113.
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15.	高玉红, 毛晓琴, 平竹仙. 尿路感染产超广谱 β 内酰胺酶大肠埃希菌和肺炎克雷伯菌耐药特征分析. 重庆医学, 2016, (3): 393-394.
16.	曾秀玉, 张华平, 陈夏容, 等. 主动干预对重症监护病房医院感染的防控效果研究. 中国循证医学杂志, 2016, 16(6): 641-645.
17.	熊凯, 史瑀. 肺炎克雷伯菌致社区感染和医院感染的耐药性调查. 中国现代医生, 2018, 56(8): 122-124, 133.
18.	贺晓珊, 梅传忠. 肺炎克雷伯菌耐药机制的研究进展. 西部医学, 2014, 26(1): 124-126.
19.	陈夏容, 张华平, 曾秀玉, 等. 社区产 ESBLs 大肠埃希菌泌尿系感染的危险因素分析. 中国循证医学杂志, 2016, 16(2): 125-129.
20.	孙长贵, 陈汉美. 超广谱 β-内酰胺酶研究进展. 国外医药(抗生素分册), 2000, 21(3): 111-115.
21.	王惠姣, 徐娇君, 陈小平, 等. ICU 患者感染多药耐药肺炎克雷伯菌的耐药性分析. 中华医院感染学杂志, 2016, 26(6): 1235-1237, 1240.

1. 张前进, 孙德明, 谢志强, 等. 肺炎克雷伯菌的临床感染特点及耐药性分析. 中华医院感染学杂志, 2014, 24(13): 3137-3138, 3141.
2. 查翔远, 宋有良, 林建, 等. 肺炎克雷伯菌血流感染的临床分布及耐药性分析. 安徽医学, 2015, (1): 71-74.
3. 季淑娟, 顾怡明, 谭文涛, 等. 中国部分地区大肠埃希菌和肺炎克雷伯菌超广谱 β 内酰胺酶基因型研究. 中华检验医学杂志, 2004, 27(9): 590-593.
4. Woodford NL, Tierno PMJ, Young K, et al. Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A beta-lactamase, KPC-3, in a New York medical center. Antimicrob Agents Chemother, 2004, 48(12): 4793-4799.
5. Keynan Y, Rubinstein E. The changing face of Klebsiella pneumoniae infections in the community. Int J Antimicrob Agents, 2007, 30(5): 385-389.
6. 凌勇, 肖洪广, 邱芳华. 耐碳青霉烯肺炎克雷伯菌的耐药基因分析. 热带医学杂志, 2018, 18(3): 358-361.
7. 胡付品, 郭燕, 朱德妹, 等. 2017 年 CHINET 中国细菌耐药性监测. 中国感染与化疗杂志, 2018, 18(3): 241-251.
8. 何足元, 陈志敏. 医院内感染和社区感染儿童肺炎克雷伯杆菌临床特点及耐药性分析. 重庆医学, 2013, (36): 4382-4384.
9. 赵玉杰, 王丽, 吕艳关. 2015-2017 年某院产超广谱 β 内酰胺酶大肠埃希菌耐药性及其所致感染性疾病的危险因素分析. 现代医药卫生, 2018, 34(21): 3315-3317.
10. Meier S, Weber R, Zbinden R, et al. Extended-spectrum beta-lactamase-producing gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy. Infection, 2011, 39(4): 333-340.
11. 黄艳飞, 张嘉琦. ESBL 阳性肺炎克雷伯菌所致肺炎临床特点和耐药性分析. 标记免疫分析与临床, 2018, 25(7): 929-934.
12. 吴雪花, 陈林俊, 徐华. 外科手术部位感染常见病原菌及其耐药性分析. 现代实用医学, 2014, 26(10): 1308-1309.
13. 马利. 某院大肠埃希菌与肺炎克雷伯菌感染的临床特征及耐药分析. 临床医学研究与实践, 2018, 3(11): 99-100, 113.
14. Boix-Palop L, Xercavins M, Badia C, et al. Emerging extended-spectrum β-lactamase-producing Klebsiella pneumoniae causing community-onset urinary tract infections: a case-control-control study. Antimicrob Agents, 2017, 50(2): 197-202.
15. 高玉红, 毛晓琴, 平竹仙. 尿路感染产超广谱 β 内酰胺酶大肠埃希菌和肺炎克雷伯菌耐药特征分析. 重庆医学, 2016, (3): 393-394.
16. 曾秀玉, 张华平, 陈夏容, 等. 主动干预对重症监护病房医院感染的防控效果研究. 中国循证医学杂志, 2016, 16(6): 641-645.
17. 熊凯, 史瑀. 肺炎克雷伯菌致社区感染和医院感染的耐药性调查. 中国现代医生, 2018, 56(8): 122-124, 133.
18. 贺晓珊, 梅传忠. 肺炎克雷伯菌耐药机制的研究进展. 西部医学, 2014, 26(1): 124-126.
19. 陈夏容, 张华平, 曾秀玉, 等. 社区产 ESBLs 大肠埃希菌泌尿系感染的危险因素分析. 中国循证医学杂志, 2016, 16(2): 125-129.
20. 孙长贵, 陈汉美. 超广谱 β-内酰胺酶研究进展. 国外医药(抗生素分册), 2000, 21(3): 111-115.
21. 王惠姣, 徐娇君, 陈小平, 等. ICU 患者感染多药耐药肺炎克雷伯菌的耐药性分析. 中华医院感染学杂志, 2016, 26(6): 1235-1237, 1240.

Chinese Journal of Evidence-Based Medicine

Clinical characteristics and drug resistance of Klebsiella pneumoniae in patients with nosocomial and community infections in Quanzhou, China

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