| Objectives:1.To conduct a retrospective study on the epidemiological data and related risk factors associating the prognosis of K.pneumoniae infection cases in the Emergency Department of Renji Hospital between 2014-2017.2.To investigate the drug susceptibilities of the K.pneumoniae infection among inpatients of the emergency department of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine.As a typical clinical condition of K.pneumoniae infection,information of pyogenic liver abscess was studied on the clinical features and drug sensitivity or resistance data,to provide valuable clinical evidence for diagnosis and treatment.3.Our aim in this study was to investigate the clinical characteristics and risk factors of carbapenem-resistant K.pneumoniae(CRKP)infections in the Emergency Department of Renji hospital.Methods:1.Patients registered as K.pneumoniae infection the Emergency Department of Renji Hospital from January 2014 to December 2017 were enrolled in this study.Clinical and laboratory data including demographics,body fluid culture and clinical outcomes were collected and analyzed.Among them,detailed information of patients who were admitted to emergency ward or emergency intensive care unit(EICU)was further studied,focusing on the clinical features including demographics,underlying diseases,managements,drug susceptibility test results,hospitalization length and clinical outcomes.2.Patients who registered as K.pneumoniae infection the Emergency Department of Renji Hospital from January 2014 to December 2017 were enrolled in this study.ESBLs and antibiotic resistance of all strains were detected,and to clarify the clinical features and drug resistance of K.pneumoniae liver abscess.3.A retrospective analysis of 46 cases(research group)with CRKP infection in the emergency department of our hospital from 2014 to 2017,were matched 1:1 by case control group whose drug susceptibility demonstrated carbapenems sensitive.The patients with K.pneumoniae infection in control group were admitted to the hospital during the same period,the same gender and age(±5 years),Univariate analysis and multivariate binary logistic regression analysis were performed on the multiple factors of the two groups to identify relevant risk factors of patients with CRKP infection.Results:1.1 A total of 377 cases with K.pneumoniae infection were enrolled in this study,male dominated the major compared to female(1.31:1).The median age was 68(58,82)years old,with a highest incidence in the 50-89 year old groups(79.05%),the peak age was 80-89 year old(23.08%).The major distribution of K.pneumoniae infection was the area of resuscitation room and observation units of Emergency Department,accounting for more than50% of the total number of the infectious strains per year.The sources of the samples positive for K.pneumoniae were mainly sputum culture(39.52%),followed by urinary culture(33.42%),and liver pus culture(9.02%).1.2 There were 132 hospitalized patients selected from the cohort above,with the male:female of 1.54:1.The median age was 73 years old,with a higher incidence in the 50-89 year old groups(87.12%),and peak age at80-89 years(30.30%).Among the body fluid culture specimens,the sputum specimens occupied the most one(51.5%),followed by liver pus specimens(20.5%)and blood culture specimens(12.1%).Type 2 diabetes was the most common underlying diseases(38.6%),followed by heart disease(37.1%).Among the disease types,liver abscess accounted for29.5%,which had a better clinical outcome for K.pneumoniae infection(P=0.001).Fifty-three patients were admitted to the EICU(40.2%),and 15 patients underwent invasive mechanical assisted ventilation during hospitalization(11.4%).In terms of outcomes,119 patients(90.2%)were improved and 13 patients(9.8%)were died.Admitted into EICU and high neutrophil-to-lymphocyte count ratio(NLR)were risk factors for the death outcome.Furthermore,binary logistic regression analysis revealed that NLR was an independent risk factor for death outcome in patients with K.pneumoniae infection,and it had a good predictive effect on the death outcome of K.pneumoniae infection(AUC=0.799,P<0.001,CI95%0.671-0.926).2.A total of 132 strains and corresponding cases were retrieved and enrolled.Among the 132 strains of K.pneumoniae,the number of sputum specimens was the highest,with 68 strains(51.5%),followed by specimens of liver pus(20.5%)and blood culture(12.1%);the most common type of infection was pulmonary infection(57.6%),followed by liver abscess(29.5%)and urinary tract infection(11.4%).For pyogenic liver abscess as an typical disease,the average age of patients with liver abscess was 60.77±14.23,which was younger than that of non-liver abscess group.The number of patients with diabetes was significantly higher than that of non-liver abscess group(P=0.006).Meanwhile,the drug resistant rate of liver abscess isolate(hypervirulent Klebsiella pneumoniae,hv KP)was significantly lower than that of non-liver abscess group(P<0.05).The detection rate of ESBLs in liver abscess isolates was 7.7%.One isolate was found to be resistant to carbapenems.3.Of the 46 patients with carbapenem-resistant K.pneumoniae infection,ratio of male to female was1.56:1.The average age of the patients was76.59 ± 11.48 years.Univariate outcome analysis found that a combination of chronic kidney disease,long-term hospitalization history,admission to EICU,mechanical ventilation,previous use of carbapenems and glycopeptides,along with invasive procedures during hospitalization were risk factors for CRKP(P<0.05)infection.Multivariate logistic regression analysis screened out three independent risk factors,which were carbapenem exposure during hospitalization(OR=15.130,P<0.001),invasive operation during hospitalization.(OR=16.775,P=0.002)and mechanical ventilation(OR=13.503,P=0.005);At the same time,we found that the mortality rate of the patients in the CRKP group(23.9%)was significantly higher than that in the CSKP group(0.0%).After comparing the survival patients with the death patients,we found that the infection of CRKP was significantly correlated with the death outcome of patients in the univariate analysis(P<0.001),but multivariate binary logistic regression analysis found that carbapenem resistance was not associated with death outcomes.Admission to EICU and previous long-term care hospital history was an independent risk factor associated with patient death outcomes.Conclusions:1.The most common body fluid for pathogen culture of K.pneumoniae was sputum specimens,followed by urinary specimens.Diabetes was the most common underlying disease of K.pneumoniae infection;Liver abscesses have a relatively good clinical outcome in patients with K.pneumoniae infection.NLR and MLR were the risk factors associated with intensive care unit admission and the prognosis of K.pneumoniae infection;NLR had a predictive value for the outcomes of K.pneumoniae infection.2.The most common infection type of K.pneumoniae was lung,the second was pyogenic liver abscess;K.pneumoniae liver abscess is caused by hypervirulent K.pneumoniae,which is sensitive to most antibiotics and the detection of the ESBLs is rare.3.Patients with CRKP infection have higher mortality and poorer prognosis.Risk factors included exposure to carbapenem during hospitalization,invasive procedures during hospitalization,and mechanical ventilation. |
PDF Full Text Request