| Objectives:Klebsiella pneumoniae(K.pneumoniae)is an important opportunistic pathogen causing hospital acquired infection.In China,the isolation rate of K.pneumoniae in recent five years ranks the second among gram-negative bacilli.With the extensive use of broad-spectrum antibiotics,the drug resistance of K.pneumoniae is gradually increasing,and the phenomenon of multiple drug resistance is serious.Therefore,the study on the biological characteristics and drug resistance of K.pneumoniae in the first hospital of Jilin university can provide reference for the prevention and treatment of clinical K.pneumoniae infection.In addition,the clinical cases of patients with bloodstream infections of K.pneumoniae were analyzed,aiming to clarify the risk factors of cephalosporin-resistant K.pneumoniae and multi-drug resistant K.pneumoniae(MDR-KP)infection and clinical characteristics of patients infected with drug-resistant strains in order to facilitate the assessment of the condition.Before the blood culture bacterial identification and drug susceptibility test results are not available,guide the clinical reasonable construction scheme of anti-infection,and timely and effective prevention and control measures are taken to reduce nosocomial infection.Methods:In this study,28 strains of K.pneumoniae isolated from whole blood samples in the first hospital of Jilin University were collected,and the distribution of serotypes,drug resistance to commonly used clinical antibiotics and the carrying of cephalosporin antibiotic resistance genes were analyzed.At the same time,the clinical data of 28 K.pneumoniae patients with bloodstream infections from 28 strains of K.pneumoniae(including gender,age,smoking/drinking history,length of stay before infection,use of antibiotics before infection,places where infections were obtained,underlying diseases,laboratory tests and prognosis,etc.)were retrospectively analyzed,and logistic regression analysis was used to analyze the risk factors of drug-resistance K.pneumoniae infection.Results:(1)Among the 28 strains of K.pneumoniae,K1 was the most important serotype.In addition,there were K2,K20,K16,K24,K3 and K28 serotypes.(2)28 strains of K.pneumoniae had the highest resistance rate to ampicillin(penicillins),cefazolin(first generation cephalosporins)and piperacillin(penicillins),followed by ampicillin / sulbactam(penicillin / β lactamase inhibitor),cefuroxime(second generation cephalosporins),ciprofloxacin(quinolones)and compound sulfamethoxazole(sulfonamides).The resistance rate to imipenem,meropenem(carbapenems)and amikacin(aminoglycosides)was the lowest.(3)The higher the generation,the lower the resistance rate to cephalosporins.The resistance rate to the first generation cephalosporin(cefazolin)was 100%,to the second generation cephalosporin(cefuroxime)was 46.4%,to the third generation cephalosporin(ceftazidime and ceftriaxone)was 28.6% and 39.3%,respectively,and to the fourth generation cephalosporin(cefepime)was only 21.4%.(4)Among the 28 strains of K.pneumoniae,18 strains were multidrug-resistant,including 1 strain resistant to 3 kinds of antibiotics,6 strains resistant to 4 kinds of antibiotics,1 strain resistant to 5 kinds of antibiotics,7 strains resistant to 6 kinds of antibiotics,3 strains resistant to 7 kinds of antibiotics.(5)The carrying status of cephalosporins related drug resistance genes from more to less was TEM gene,SHV gene,CTX-M-1 gene,DHA gene,CTX-M-9 gene.Among them,22 strains of K.pneumoniae carried TEM and SHV gene,and only 5strains of K.pneumoniae carried CTX-M-9 gene.(6)Patients infected with cephalosporin-resistant K.pneumoniae and MDR-KP were both younger than the non-resistant group,and the difference was statistically significant.Moreover,patients who were hospitalized for several days before infection,hospital-acquired,and patients with hematological diseases were more likely to be infected resistant to K.pneumoniae and MDR-KP.(7)The red blood cells,hemoglobin,neutrophil absolute value,urea,creatinine,and procalcitonin of patients infected with cephalosporin antibiotic resistance K.pneumoniae were lower than those of the non-resistant group,and the carbon dioxide binding capacity was higher than that of the non-resistant group.The difference was statistically significant.(8)Patients infected with MDR-KP had the same characteristics as those infected with cephalosporin antibiotic resistant K.pneumoniae.White blood cells,the absolute value of lymphocytes,platelets,aspartate aminotransferase,alanine aminotransferase,and direct bilirubin in the MDR group were also lower than those in the non-MDR group.The difference was statistically significant.Conclusion:(1)Among the 28 K.pneumoniae strains,K1 was the most important serotype,and the ESBLs genotypes were mainly TEM and SHV.(2)28 clinical isolates of K.pneumoniae were only sensitive to carbapenems and aminoglycosides,but resistant to penicillins,cephalosporins,quinolones and sulfonamides,and the multiple drug resistance was serious.(3)Blood system diseases and long-term hospitalization were the risk factors of MDR / cephalosporin-resistant K.pneumoniae infection. |
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