| BackgroundKlebsiella pneumoniae(KPN)is a type of opportunistic bacteria in the Enterobacteriaceae family.It can normally reside in the respiratory tract and intestinal tract.But it has a strong pathogenicity,it will enter the lung tissue through the respiratory tract when the body’s immunity is reduced,and cause the fusion consolidation of lobules or lobules,forming single or multiple abscesses.The lesion can involve multiple organs,it is difficult to treat and the fatality rate is high.For the past few years,the detection rate of KPN and its antibiotic-resistant strains keep rising,and the detection rate of KPN in a primary hospital is higher,which increase the challenge of clinical anti-infection treatment and seriously endanger the life and health of patients.Therefore,the study about the clinical distribution,antibiotic resistance and homology of KPN will effectively help the treatment of clinical KPN infection,the rational use of antimicrobial agents and the prevention and control of nosocomial infection.ObjectiveTo study the clinical distribution characteristics and antibiotic resistance of KPN,and analyze the reasons for the high detection rate of KPN clear and whether there is the prevalence of nosocomial clone strains between different departments.Our study will provide the scientific basis for clinical anti-infection treatment,rational antibiotics use and nosocomial infection management.Methods1.Retrospectively analyzed the detection rate,clinical distribution and resistance to commonly used antibiotics of KPN isolated in microbiology laboratory during 2016 to2019 in a grade II A general hospital(a member of Antimicrobial Resistance Surveillances System of Henan Province)in Xuchang,Henan province.2.KPN were isolated from the clinic during the high incidence period of pneumonia in 2019.The antibiotic sensitivity test results showed that KPN was resistant to three or more antibiotics simultaneously.The homology of KPN was analyzed using repetitive sequence polymerase chain reaction(REP-PCR).3.Statistical methodsClinical data and antibiotic resistance rate of KPN were summarized and analyzed using WHONET5.6 system.The statistical software SPSS19.0 was used for chi-square test.P< 0.05 was considered as the significant difference critical.If P < 0.01,the difference is extremely significant.Cluster analysis was used for homology.Results1.The detection rate of KPN.From 2016 to 2019,3196,3134,2993 and 2154 strains of bacteria were isolated each year in a primary hospital,among which the detection rates of KPN were 21.8%,23.7%,22.5% and 24.1%,respectively.There was statistical significance in the detection rate of KPN among different years from 2016 to 2019(P<0.01).2.The specimen source of KPN.The main sources of specimens were sputum(76.9%),urine(9.4%),pus(5.1%),blood(3.1%),drainage fluid(2.0%)and secretions(0.6%).3.The distribution of clinical departments of KPN.The three departments with the highest detection rate of KPN were department of respiratory medicine(27.9%),intensive care unit(26.5%),department of neurosurgery(12.7%).4.Resistance rate of KPN to routine antimicrobial agents and changes of antimicrobial resistance.The antibiotic resistance rate of KPN to minocycline,imipenem,meropenem,amikacin,cefoperazone/sulbactam and piperacillin/tazobactam was lower than 11%.The antibiotic resistance rates of cefazolin,cefuroxime,ceftriaxone and cotrimoxazole were relatively high and varied from 28.95% to 41.1%.The antibiotic resistance rate to ceftazidime,cefepime,and levofloxacin remained below 20%.KPN had significant statistical significance for the resistance rate of other routine antibiotics from 2016 to 2019(P<0.01),except for the resistance rates of gentamicin,chloramphenicol and minocycline(P>0.05).Among them,the antibiotic resistance rates of cefoperazone/sulbactam,piperacillin/tazobactam,cefepime and carbapenems increased the most,followed by amikacin.The antibiotic resistance of KPN varies among different departments,and the antibiotic resistance rate of neurosurgery is higher than that of intensive care medicine and respiratory medicine.5.Results of homology analysis.The 29 strains of KPN could be divided into 19 genotypes(A-S),including 3 strains of type A and B,1 strain of type C,2 strains of type D and E,1 strain of type F,4 strains of type G,1 strain of type H-M,2 strains of type N and 1 strain of type O-S.Cluster analysis showed that No.1,No.5,No.7,No.9 and No.22 had high similarity,with the homology greater than 84%.ConclusionsThe detection rate of KPN infection in a primary hospital revealed continuously increasing pattern,mainly respiratory tract infection,increased resistance to new broad-spectrum antimicrobial agents such as meropenem,cefoperazone/sulbactam and piperacillin/tazobactam.The spread of KPN infection in the hospital should be taken seriously. |
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