| Background and Objective: Klebsiella pneumoniae is a common clinical conditional pathogen second only to Escherichia coli.Klebsiella pneumoniae has attracted much attention because of Hypervirulent Klebsiella pneumoniae(hv KP)strains and increasing antimicrobial resistance year by year.The purpose of this study is to evaluate the effects of different types of Klebsiella pneumoniae infection on the prognosis of patients,to prevent over-use or delayed-use of antibiotics,and to reduce the production of drugresistant strains.Methods: The clinical data of the adult critical ill with Klebsiella pneumoniae cultured from ICUs in six tertiary hospitals in Fujian Province from January 2015 to July 2019 were retrospectively collected.According to the infection site,the patients were divided into two groups: hospital-acquired infection and community-acquired infection.According to the results of drug sensitivity test and the production of Extended-Spectrumβ-Lactamases or Klebsiella pneumoniae carbapenemase,they were divided into hv KP group,enzyme production group and ordinary group for subgroup analysis.The measurement data were analyzed by t-test or nonparametric test,and the counting data were analyzed by Chi-Square test or Fisher exact test.The basic disease status of patients with Klebsiella pneumoniae in ICU was complex,and respiratory system infection was the most common.There was significant difference in the distribution of strains between hospital-acquired infection and community-acquired infection(P<0.001).Compared with the community-acquired infection group,the duration of mechanical ventilation,the length of hospital and ICU stay in the hospitalacquired infection group were significantly higher(150(45.5,408)h VS 100(19,288)h,P=0.035;33(22,49)d VS 23(13,36)d,P<0.001;16(8,29)d VS 10(4.25,21)d,P=0.003).However,the 30-day survival rate in the community-acquired infection group was significantly lower than that in the hospital-acquired infection group(72.32% VS 84.01%,P=0.001).Compared with other groups,the total hospitalization days and ICU days of hv KP group strains were shorter(31(18,46)d VS 26(17,35.25)d,P=0.018;15(7,29)VS10(4,18.5)d,P<0.001),but the 30-day mortality rate was significantly higher than the former(27.94% VS 13.16%,P<0.001).The clinical characteristics of hv KP strains in different infection sites were also different.PCT(2.40(0.31,23.33)ng/m L VS0.52(0.10,3.09)ng/m L,P=0.014)and CRP(174.8(114.65,251.75)mg/L VS86.80(51.73,158.50)mg/L,P=0.004)in community-acquired sensitive group were significantly higher than those in hospital-acquired hv KP group.The total hospital stay in the hospital acquired hv KP group was lower than that in the community acquired infection group(23(10.5,30)d VS 29(20.5,46)d),P=0.007),but the 30-day mortality rate of community acquired infection was significantly higher than that of hospital-acquired infection(34.15% VS 12.24%,P=0.013).The production of Klebsiella pneumoniae carbapenemase in Klebsiella pneumoniae was 10.89%.It was resistant to most antibiotics and was all sensitive to tegacycline.Conclusion: The occurrence of hospital-acquired infection gave rise to worse prognosis.The strains in the hv KP group were more virulent and lethal,and the enzyme-producing strains increased the difficulty of clinical treatment,all of these needed timely interventions. |
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