| Objective In recent years,Klebsiella pneumoniae（KP）infection occupies a high position among Gram negative bacteria（GNB）,and two new KPs have emerged,namely carbapenem-resistant Klebsiella pneumoniae（CRKP）and highly virulent bacteria.Force Klebsiella pneumoniae（HvKP）.Compared with KP in the traditional sense,CRKP and HvKP will cause more damage to patients,and because these two types can be resistant to a variety of antimicrobial drugs,there is a lack of treatment options for antimicrobial drugs.More restrictions,the treatment of these two new types of KP is still in the exploratory stage,and there is no clear effective treatment method.Currently in the post-epidemic era of novel coronavirus infection,the relationship between novel coronavirus pneumonia（COVID-19）and bacterial infection is gradually emerging in severe cases,especially infections caused by multidrug-resistant pathogens,in which the drug resistance rate of KP has also increased significantly-It is a critical step to actively explore the genotype of drug resistance and identify the associated infections as soon as possible.In this study,we have executed a retrospective study of CRKP cases in a Grade Ⅲ Level A hospital of Anhui Province over the past three years to analyze the risk factors of CRKP infection with patient death.Based on the above analysis,we expected to achieve the control of nosocomial infection and the prevention of cross-infection.Our findings in exploring the characteristics of the two types of new KPs may provide new insights for future treatment options.Methods We retrospectively screened and collected the information of 303 patients with confirmed CRKP infection who were admitted to the Guangde Road Campus of the Second People’s Hospital of Hefei City,Anhui Province from June 2017 to May 2020,and collected the general medical history data of the included patients,bloodrelated indicators,drug susceptibility information,specific operations and treatment plans implemented during the patient’s admission,etc.The collected data were statistically analyzed by multivariate Logistic regression and univariate chi-square test,and the risk factors of death caused by CRKP infection were obtained.Results Among the 303 CRKP patients in this study,201 were discharged with good prognosis,and 102 died,with a case fatality rate of 33.66%（95%CI,33.56%-33.84%）.The three departments with the largest number of CRKP cases were the intensive care unit（68 cases）,the respiratory medicine department（63 cases）,and the hyperbaric oxygen department（59 cases）,accounting for 22.44%,20.79%,and 19.45%of the total cases,respectively.The total number of cases in the three departments accounted for more than half of the total number of cases in the hospital;the largest number of total specimens was sputum specimens,with a total of 231 cases,accounting for 76.24%of the total,followed by blood specimens and mid-section urine specimens.Among the factors associated with CRKP infection,there exist 13 facts serving as high-risk factors for patient death.Based on the multi-factor Logistic regression analysis,we find that there are six high-risk factors that could constitute independent risk factors for death in patients with CRKP（P<0.05）.They were:hospitalization for no less than 14 days（P=0025）,use invasive ventilator（P<0.001）,complicated with coronary heart disease（P=0.037）,admission to intensive care unit（P=0.034）,intravascular catheter（P=0.047）,and shock during hospitalization.Conclusion Many factors can lead to the death of patients with CRKP infection,and the main reason may be related to the damaged mucosal barrier in patients.Therefore,patients in high-risk departments should strictly follow the principles of aseptic operation and the implementation of hand hygiene to avoid cross-infection;high-risk patients should be subjected to prevention and early intervention to avoid unnecessary invasive operations;patients with infection should be reasonable use of antimicrobial agents in hopes of reducing mortality in patients infected with CRKP. |
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