Risk Factors Of Drug Resistance And Prognosis In Hap Patients With CRKP Infection In ICU

Objective: To analyze the risk factors and prognostic factors of hospital acquired pneumonia(HAP)patients due to carbapenem-resistant Klebsiella pneumonia(CRKP)in intensive care unit(ICU).And propose prevention and control measures,so as to reduce the incidence of CRKP infection rate,and improve outcomes of patients.Methods: A total of 73 HAP patients with Klebsiella pneumonia infection,who were treated in the ICU of a tertiary hospital in Chongqing from January 2014 to March 2016 were included.The 27 cases with CRKP were assigned as case group,46 cases with carbapenem-susceptible Klebsiella pneumonia(CSKP)were included as control group.Univariate and the logistic regression analysis were performed for the risk factors and outcomes.According to the outcomes,the 73 patients were divided into death group(21 cases)and improved / cured group(52 cases),the above methods was used to analyze the prognostic factors.Results: 1.Among the 73 HAP patients infected with Klebsiella pneumoniae,36.99%(27/73)patients were infected with CRKP,and the other 63.01%(46/73)patients were infected with CSKP.Univariate analysis found that,before infection,diabetes,chronic lung disease,renal insufficiency,ICU hospitalization time,the use of antimicrobial agents≥7 days,double combinations,triple combinations,enzyme inhibitors,carbapenems,mechanical ventilation time ≥7 days and APACHE II score were the risk factors for Klebsiella pneumoniae resistant to carbapenem antibiotics.The independent risk factors for Klebsiella pneumoniae resistant to carbapenem antibiotics were carbapenems,mechanical ventilation≥7 days and APACHE II score.2.The mortality rate of 73 HAP patients with Klebsiella pneumoniae infection was 28.77%(21/73),the mortality rate of CRKP group was 26.09%(12/46)and the CSKP group was 33.33%(9/27),there was no statistically significant difference between CRKP group and CSKP group(χ2=0.436,P=0.5091).The univariate analysis for prognosis of 73 patients with HAP showed that the risk factors for death included the use of carbapenem antibiotics and APACHE II score.And the logistic regression analysis showed that APACHE II score was the independent risk factors for death.Conclusion:The use of carbapenem antibiotics,long-term mechanical ventilation,higher APACHE II score are more likely to cause Klebsiella pneumoniae resistance to carbapenems,and the higher the APACHE II score,the higher the mortality rate.Therefore,clinical work should pay attention to the rational use of antimicrobial drugs,reduce the patient’s invasive operation,and execute hospital infection prevention and control measures in strict rotation to improve the prognosis of patients.