Clinical Analysis Of Patients With Positive Respiratory Secretion Culture Of Klebsiella Pneumoniae In A County Third-grade General Hospital

Objective To investigate the clinical characteristics and prognosis of patientswithpositive respiratory secretion culture of Klebsiella pneumoniae in a county third-grade general hospital.MethodsBy retrospective analysis,227 patients with positive respiratory secretion culture of Klebsiella pneumoniae from January to December 2017 in Kunshan First People’s Hospital were selected as subjects.They were divided into Carbapenem-resistant klebsiellapneumonia(CRKP)group(62cases)and Carbapenem-sensitive klebsiellapneumonia(CSKP)group(165 cases).The demography,basic diseases,invasive operation of CRKP group and CSKP group,and use of antibiotics in detection of KP were analyzed.According to the diagnostic criteria of hospital acquired pneumonia(HAP/VAP),109 patients with HAP were enrolled,including CRKP group(35 cases)and CSKP group(74 cases).Laboratory examinations and clinical features(including shock,body temperature,ICU admission,28-day mortality rate,APACHEII score)were analyzed.Combined with pathogen infection and analysis of the effect of carbapenems on mortality were performed.According to the outcome of 28 days,the clinical outcomes of CRKP/CSKP infection,shock,age,use of carbapenems after detection,diabetes mellitus,APACHEII score and mechanical ventilation were compared by chi-square test.Results1.Among the 227 patients,CRKP was detected in 46(26.14%)males and CSKP in 130(73.86%)females.CRKP was detected in 16(31.37%)females and CSKP in 35(68.63%)females.CRKP was detected in 25(21.01%)males and 94(78.99%)females,and CRKP in 108(31.37%)females.CRKP was detected in 37 cases(34.26%)and CSKP in 71 cases(65.74%).There was no significant difference in the detection of CRKP and CSKP between male and female groups(P=0.118),but the detection rate of CRKP in the group under 65 years old was significantly higher than that in the group over 65 years old(P=0.015).2.Among 227 patients,there were 29 patients with respiratory diseases(4in CRKP group and 25 in CSKP group).There were 74 patients with stroke(21 in CRKP group and 53 in CSKP group).There were 70 patients with craniocerebral trauma(24 in CRKP group and 46 in CSKP group).Stroke was the most common complication,followed by craniocerebral trauma,and respiratory diseases.3.Among 227 patients,the results showed that gastric tube(X2=10.45,P<0.001);deep venous catheter(X2=6.22,P<0.05);urethral catheter(X2=10.53,P<0.001);tracheal intubation(X2=6.18,P<0.05);invasive mechanical ventilation(X2=2.12,P<0.05),would lead to the increase of CRKP infection rate.4.Among 227 patients with positive culture of Klebsiella pneumoniae in respiratory secretion,41 patients were treated with carbapenem antibiotics before detection of KP,including 22 CRKP and 19 CSKP patients;186 patients were treated with non carbapenem antibiotics,including 39 CRKP and 147 CSKP patients.The results showed that the detection rate of CRKP was higher in carbapenems(X2=18.27,P=0.001).5.In 109 HAP/VAP patients,there were significant differences in lymphocyte levels between CRKP subgroup and CSKP subgroup(1.00±0.48*109/L vs 0.71±0.39*109/L,P=0.001).Platelet levels between CRKP subgroup and CSKP subgroup were significantly different(185.77 ± 130.35*109/L vs 143.18±77.71*109/L,P=0.037).Results showed lymphocyte levels in CSKP subgroup were lower than those in CRKP subgroup,but the platelets in CSKP subgroup were lower than those in CRKP subgroup.6.In 109 patients with positive culture of Klebsiella pneumoniae in the respiratory secretions of HAP/VAP,KP detection time,57 patients were complicated with other pathogens.14 cases were associated with Acinetobacter baumannii,including 8 cases of CRKP and 6 cases of CSKP;12 cases of Pseudomonas aeruginosa,including 8 cases of CRKP and 4 cases of CSKP.The other pathogens were less complicated with infection.7.In 109 HAP/VAP patients,there were no significant differences in shock(P=0.14),body temperature(>38℃)(P=0.07),ICU(P=0.10),28-day mortality(P=0.18),APACHEII score(P=0.17)between CRKP and CSKP subgroups.The results showed that there was no significant difference in the severity and prognosis of HAP/VAP patients with CRKP or CSKP infection between the two groups.8.109 HAP/VAP patients were divided into groups according to whether carbapenem antibiotics were usedafter detection of KP.There was no significant difference between CRKP subgroup and CSKP subgroup(X2=0.09,P=0.31);there was no significant difference between CRKP subgroup and CSKP subgroup with non carbapenem antibiotics(X2=0.06,P=0.21).9 The clinical outcomes of 109 patients with HAP/VAP were analyzed retrospectively,and the results showed that shock(OR=2.740,95%CI 1.056-7.109,P=0.038)and age(OR=2.966,95%CI 1.215-7.244,P=0.017)were independent risk factors affecting the prognosis of patients.However,CRKP infection(OR=1.703,95%CI 0.554-5.235,P=0.352),APACHE Ⅱ>15 points(OR=2.225,95%CI 0.592-8.370,P=0.237),carbapenems(OR=0.504,95%CI 0.136-1.865,P=0.305),diabetes(OR=0.327,95%CI 0.065-1.660,P=0.178),invasive mechanical ventilation(OR=1.683,95%CI 0.487-5.813,P=0.410)had no effect on the outcome.Conclusions1.CRKP and CSKP were detected in respiratory secretions of hospitalized patients,and the detection rate of CRKP in patients under 65 years old was significantly higher than that over 65 years old.The top three basic diseases were stroke,craniocerebral injury and chronic respiratory diseases.The detection of CRKP was related to the invasive operation.The detection rate of CRKP in KP patients using carbapenems before detection was higher than that of KP patients with non carbapenems.2.Among all Klebsiella pneumoniae detected,109 cases were diagnosed according to HAP/VAP,accounting for 48%of the total number.In HAP/VAP group,the lymphocyte and platelet counts of CSKP subgroup were lower than those of CRKP subgroup.When KP was detected,Acinetobacter baumannii was the most common,followed by Pseudomonas aeruginosa.There was no significant difference between CRKP subgroup and CSKP subgroup in clinical severity and prognosis of HAP/VAP patients.No matter whether carbapenems were used or not,there was no significant difference in the mortality between CRKP and CSKP subgroups.3.Old age and shock can significantly increase the mortality rate of Klebsiella pneumoniae positive HAP/VAP patients,while CRKP,APACHE II score>15 points,diabetes mellitus,invasive mechanical ventilation and carbapenems after detection have no significant effect on the mortality rate of HAP/VAP patients.