| To analyze the clinical characteristics and risk factors of elderly patients with carbapenem-resistant Klebsiella pneumoniae(CRKP)pulmonary infection in our hospital from 2020 to 2022,in order to take appropriate prevention and control measures to reduce the occurrence of CRKP,reduce the incidence of pulmonary infection,early diagnosis and accurate treatment,improve the prognosis of patients and reduce the economic burden of patients;and provide the basis for clinical intervention.A total of 113 elderly patients diagnosed with Klebsiella pneumoniae(KP)pulmonary infection in Hebei Provincial People’s Hospital were collected and divided into carbapenem-resistant Klebsiella pneumoniae(CRKP)group(63 cases)and carbapenem-susceptible Klebsiella pneumoniae(CSKP)group(50 cases)according to drug susceptibility results.Data collection included basic information on admission and relevant laboratory data.SPSS 25.0 software was used to investigate the clinical characteristics of pulmonary infection in elderly patients with CRKP,and univariate analysis and binary logistic regression analysis were used to analyze the risk factors.This study1.A total of 113 elderly patients with KP pulmonary infection were included,91(80.5%)males and 22(19.5%)females,aged between 60 and 96 years.They were divided into 2 groups according to whether they were carbapenem-sensitive or not: 63 patients in the CRKP group,48 males(76.2%),with a median age of 82 years(interquartile range,70 to 89 years);50 patients in the CSKP group,43 males(86.0%),with a median age of 79.5 years(interquartile range,67 to 86.25 years);there was no statistically significant difference in gender or age between the two groups(P > 0.05).The albumin content in the CSKP group(30.16± 4.81)g was higher than that in the CRKP group(28.07 ± 3.82)g,with statistical significance between the two groups(P = 0.011).ICU admission was higher in the CRKP group compared with the CSKP group(63.5%versus 38.0%,P = 0.007).In addition,there were statistically significant differences between the CRKP pulmonary infection group and the CSKP-infected group in the six factors of bronchoscopy(P = 0.006),endotracheal intubation(P < 0.001),thoracentesis(P = 0.042),combined malignancies(P = 0.037),carbapenems within 30 days before infection(P< 0.001),and quinolones(P = 0.027)drugs in elderly patients.2.Independent variables with P < 0.10 were included in multivariate analysis,and the results showed that endotracheal intubation before KP nfection(P = 0.048,OR = 3.845)and carbapenems within 30 days before KP infection(P = 0.037,OR = 3.520)were independent risk factors for CRKP pulmonary infection in elderly patients.3.The departments detected by KP,CRKP,and CSKP were mainly ICU,respiratory medicine,and neurology.The results showed that the sensitivity of KP to tigecycline and colistin was the highest: among 63 strains of CRKP,the resistance rate to tigecycline was 7.9% and the resistance rate to colistin was 3.2%;among 50 strains of CSKP,the resistance rate to tigecycline was only 2.0% and all were sensitive to colistin.In addition,the resistance rates to ceftazidime,ciprofloxacin,and levofloxacin in the CRKP group were more than 95%;the resistance rates to piperacillin sodium tazobactam,cefoperazone sulbactam sodium,cefepime,aztreonam,imipenem,and meropenem were as high as 100%.In summary,CRKP is a common pathogen of nosocomial infection,and the detection rate of CRKP in elderly patients with pulmonary infection is high,and the sensitivity to drugs is poor,which brings difficulties to clinical treatment.The key to prevent CRKP infection lies in correctly evaluating the condition and using invasive procedures rationally,mastering the indications for medication,and accurately using antibacterial drugs. |
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