Objective To investigate the clinical characteristics and drug resistance changes of nosocomial infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in different types of clinical departments, and to provide evidence for prevention and control of CRKP infection. Methods The hospital infection real-time monitoring system was used to retrospectively collect the inpatients with CRKP nosocomial infection in the First People’s Hospital of Lianyungang from January 2019 to December 2023 as the research objects. According to the different sources of departments, they were divided into intensive care unit (ICU) group, internal medicine group and surgery group. The changes of clinical characteristics and drug resistance to common antibiotics were analyzed. Results A total of 636188 inpatients were monitored, and 225 cases were infected with CRKP, with an overall infection detection rate of 0.035%. The detection rates of CRKP infection in the ICU group, internal medicine group, and surgery group were 0.736% (138/18749), 0.013% (44/336777), and 0.015% (43/280662), respectively, with the ICU group demonstrating a significantly higher rate than the other groups (P<0.05). The detection rates fluctuated in the early stage and then decreased rapidly in different years. The main infection site of CRKP in all groups was lower respiratory tract, but the proportion of device-related infections in the ICU group was higher than that in the internal medicine and surgery groups (P<0.05). In terms of the infected population, there was no significant difference in gender among groups (P>0.05) with the proportion of males more than 60%, while the difference in the proportion of patients aged ≥65 years among groups was statistically significant (P<0.05), with the highest in the internal medicine group (86.36%). The burden of underlying diseases and invasive operation exposure of the infected patients were high, and the proportion of cardiovascular and cerebrovascular diseases and indwelling catheters were as high as 69.33% and 83.56%, respectively. The differences in the proportions of cardiovascular and cerebrovascular diseases, diabetes mellitus, ≥3 underlying diseases, and surgical and invasive procedures among groups were statistically significant (P<0.05). The distribution of infection specimens in each group showed no statistically significant difference (P>0.05), with sputum, blood, and mid-stream urine specimens being the main detected specimens in all groups. The resistance rates of CRKP to penicillins and cephalosporins were more than 93%, and the resistance rates to aminoglycosides and sulfonamides were relatively low and showed a decline year by year. The resistance rate to ceftazidime/avibactam was only 7.41%, but the resistance rate to tigecycline increased. The difference in resistance rate of CRKP to co-trimoxazole among groups was statistically significant (P<0.05), while the differences in resistance to other antimicrobial agents were not statistically significant (P>0.05). Conclusions The detection rate, clinical characteristics and drug resistance of CRKP infection in different types of departments of medical institutions are different and changing. It is necessary to strengthen the rational use of antibiotics and the prevention and control of nosocomial infection.
Liver transplantation is currently the only effective curative treatment for end-stage liver disease. In recent years, with advancements in liver transplantation surgery and anti-rejection drugs, the incidence of surgical complications and organ rejection has gradually decreased. Conversely, transplant-related infections have increasingly become a major factor affecting the prognosis of transplant recipients. Furthermore, due to the progress in critical life support technologies, the time spent in the donor’s intensive care unit (ICU) has been extended, and post-transplant infections originating from the donor, especially donor-derived infection (DDI), have become one of the primary sources of infection for recipients. Studies have shown that infections in liver transplant recipients are often caused by Gram-negative pathogens, particularly carbapenem-resistant Klebsiella pneumoniae (CRKP), which has now become the leading cause of fatal infections in liver transplant recipients. To reduce the risk of donor-derived infections, it is necessary to strengthen donor screening and evaluation, establish standardized testing processes, and adjust the use strategies of post-transplant anti-infective drugs and immunosuppressants. Monitoring the immune status of recipients is also crucial. Multidisciplinary collaboration and the application of new technologies will be key in future infection prevention and control. To promote the prevention and treatment of CRKP-related donor infections, West China Hospital of Sichuan University, in collaboration with international experiences, has organized relevant experts to develop an expert consensus on the prevention and treatment of CRKP-targeted DDI.
ObjectivesTo detect the admission rate and hospital acquired rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Acinetobacter baumannii (CRAB) of active surveillance in Emergency Intensive Care Unit patients of West China Hospital of Sichuan University, to examine whether rectal colonization of CRKP and CRAB are associated with nosocomial infection, so as to provide a scientific basis for the prevention and control of CRKP and CRAB.MethodsA nested case-control study was conducted between April and September 2018 in Emergency Intensive Care Unit. Rectal swabs were obtained to screen CRAB and CRKP, and the admission rate of colonization was calculated. According to whether infected with CRKP/CRAB, the patients were divided into case group (infection group) and control group (noninfection group) to determine whether colonization of CRKP/CRAB were independent risk factors for nosocomial infection using logistic regression model.ResultsThe admission rate of CRKP and CRAB patients were 4.08% (18/441) and 8.78% (38/433), and the nosocomial infection rate was 3.63% (16/441) and 18.01% (78/433) separately. Multivariate analysis showed that rectal colonization of CRKP [odds ratio=5.438, 95% confidence interval (1.643, 17.999), P=0.006] was an independent risk factor for nosocomial infection. However, there was no statistical correlation between rectal colonization of CRAB and nosocomial infection [odds ratio=1.449, 95% confidence interval (0.714, 2.942), P=0.305].ConclusionsThe rectal colonization rate of CRAB is higher than that of CRKP, but it does not increase the risk of CRAB infection in patients. Rectal colonization of CRKP is an important factor for infection of patients. Therefore, early detection of CRKP through active surveillance and taking control measures can help reduce the risk of its spread in the hospital.
Objective To explore the colonization of Klebsiella pneumoniae in the intensive care unit of our hospital and analyze the risk factors. Methods A total of 226 patients were actively screened in the surgical intensive care unit and neurosurgery intensive care unit from June to December 2020 in the hospital, and their clinical data were retrospectively analyzed. Results Totally, 87 strains of Klebsiella pneumoniae were screened out, 69 strains were carbapenem-resistant Klebsiella pneumoniae (CRKP), and the resistant genotype was mainly KPC genotype (79.6%). The resistance rates of meropenem were 75.0% and 77.4%, respectively. Age and pulmonary infection before admission are risk factors for CRKP colonization, while pulmonary infection before admission is an independent risk factor for CRKP colonization. Conclusions Both the CRKP colonization rate of patients and the rate of resistance to carbapenem antimicrobials are relatively high in the intensive care unit of our hospital. Pulmonary infection before admission is an independent risk factor for CRKP colonization.
Objective To analyze the current drug resistance and risk factors of hospital acquired pneumonia( HAP) due to extended spectrumβ-lactamase ( ESBLs) producing Escherichia coli and Klebsiella pneumoniae, and to estimate the prevalence trend of ESBLs producing strains. Methods FromApril 2007 to January 2008, 140 patients of Xinhua Hospital with HAP due to E. coli and K. pnermoniae were enrolled.Among them, 88 patients were with ESBLs producing strains and 52 patients were with non-ESBLs producing strains. Risk factors were analyzed by comparing between these patients. The rate of drug resistance was determined by antibiotic sensitive test. Fifty-three ESBLs producing strains were genotyped by random amplified polymorphic DNA ( RAPD) . Results The rate of drug resistance of ESBLs producing strains washigher than that of non-ESBLs producing strains. ICU stay, use of third- and forth-generation cehpalosporin were found to be the independent risk factors by multivariate analysis with logistic regression. By RAPD, 37 ESBLs producing E. coli strains were divided into 27 types and 16 ESBLs producing K. pneumoniae strains were divided into 13 types. Conclusions ICU stay, use of third-generation and forth-generation cehpalosporin remain as major risk factors in the HAP due to ESBLs producing E. coli and K. pneumoniae.RAPD is an economic, quick and credible method for epidemic analysis
Compared to classical Klebsiella pneumoniae, hypervirulent Klebsiella pneumoniae (hvKP) exhibits stronger pathogenicity and a greater ability to evade host immune responses. Infections caused by hvKP typically manifest as more severe diseases with higher mortality rates, thereby increasing the complexity and challenges of clinical treatment. The emergence of carbapenem-resistant hvKP (CR-hvKP) exacerbates this predicament. Although there is still confusion regarding the clinical definition and detection standards for hvKP, this article systematically explains the clinical infection characteristics, identification methods, and mechanisms behind the emergence of CR-hvKP. This can enhance clinical staff’s vigilance towards hvKP infections and offer comprehensive and detailed considerations for the diagnosis and treatment of such strains.
Hypervirulent Klebsiella pneumoniae has the characteristics of high virulence and high viscosity, which can cause pneumonia, bacteremia, liver abscess, meningitis and other diseases, and in severe cases, it can be life-threatening. At present, studies on the pathogenic mechanism of hypervirulent Klebsiella pneumoniae showed that siderophore virulence genes play an important role in it. The siderophores closely related to hypervirulent Klebsiella pneumoniae virulence mainly include aerobactin, enterobactin, yersiniabactin and salmochelin. Siderophore-related virulence genes mainly include aer, iucB, iroNB and kfuBC. This article focuses on a brief review of the role of siderophore virulence genes in the pathogenic mechanism of hypervirulent Klebsiella pneumoniae, and aims to guide infection control.
Objective To investigate the iron regulated locus in Klebsiella pneumoniae isolates from blood culture of liver abscess patients in Sichuan Provincial People’s Hospital. Methods From January to December of 2015, a total of 10 isolates of Klebsiella pneumoniae were collected from blood culture of liver abscess patients from Sichuan Provincial People’s Hospital. The genomic DNA was extracted to identify the genes of iroB, iroC, and iroD by PCR, and data was further analyzed by Graphpad Prism 5 software. Results Among the 10 Klebsiella pneumoniae clinical strains, 9 strains were iroB positive strains, 9 strains were iroC positive strains, and 10 strains were iroD positive strains, 9 strains were iroB/C/D triple positive. Conclusion The current study suggests that the frequency of triple positive of iroB/C/D in Klebsiella pneumoniae is high in isolates from liver abscess patients, the triple positive of iroB/C/D may contribute to liver abscess.
Objective To compare the screening ability of modified Hodge test (MHT), modified carbapenem inactivation method (mCIM) and EDTA-carbapenem inactivation method (eCIM) for drug resistance phenotype of carbapenemase-producing Klebsiella pneumoniae. MethodsCarbapenem resistant Klebsiella pneumoniae (CRKP) strains clinically isolated from 5 hospitals in Chengdu between January 2019 and December 2021 were collected, and the carbapenem sensitive Klebsiella pneumoniae (CSKP) strains isolated in the same period were randomly collected. Polymerase chain reaction (PCR) -amplified carbapenem resistance gene as the gold standard, the consistencies between the results of the three phenotypic tests and the results of genetic testing were compared. Results A total of 160 CRKP strains and 120 CSKP strains were isolated. Among the 160 CRKP strains, carbapenem resistance genes were detected in 156 strains, including 105 strains of blaKPC-2, 41 strains of blaNDM-1, 8 strains of blaKPC-19, 1 strain of blaIMP-1, and 1 strain carrying both blaKPC-2 and blaNDM-1. None of the 120 CSKP drug resistance genes were detected. The sensitivity and specificity of carbapenem screening for MHT and mCIM were 73.08% (114/156), 96.67% (116/120), 97.44% (152/156) and 98.33% (118/120), respectively. The sensitivity and specificity of eCIM for screening metalloenzymes were 95.35% (41/43) and 100% (120/120), respectively. Conclusions The sensitivity of MHT to detect carbapenemase is lower than that of the other two methods, and it is easy to produce false negatives when it is used to detect metalloenzymes. The mCIM has high sensitivity and is consistent with the PCR genetic test results. The combined detection of mCIM and eCIM can screen carbapenemases more effectively and distinguish the types of carbapenemases.
Objective To investigate the risk factors for Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections, and construct a clinical model for predicting the risk of CRKP infections. Methods A retrospective analysis was performed on Klebsiella pneumoniae infection patients hospitalized in the Third Hospital of Hebei Medical University from May 2020 to May 2021. The patients were divided into a CRKP group (117 cases) and a Carbapenem-sensitive Klebsiella pneumoniae (CSKP) group (191 cases). The predictors were screened by full subset regression using R software (version 4.3.1). The truncation values of continuous data were determined by Youden index. Nomogram and score table model for CRKP infections risk prediction was constructed based on binary logistic regression. The receiver operator characteristic (ROC) curve and area under curve (AUC) were used to evaluate the accuracy of models. Calibration curve and decision curve were used to evaluate the performance of models. Results308 patients with Klebsiella pneumoniae infections were included. A total of 8 predictors were selected by using full subset regression and truncation values were determined according to Youden index: intensive care unit (ICU) stay at time of infection>2 days, male, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score>15 points, hospitalization stay at time of infection>10 days, any history of Gram-negative bacteria infection in the last 6 months, heart disease, lung infection, antibiotic exposure history in the last 6 months. The AUC of CRKP prediction risk curve model was 0.811 (95%CI 0.761 - 0.860). When the optimal cut-off value of the constructed CRKP prediction risk rating table was 6 points, the AUC was 0.723 (95%CI 0.672 - 0.774). The Bootstrap method was used for internal repeated sampling for 1000 times for verification. The model calibration curve and Hosmer-Lemeshow test (P=0.618) showed that these models have good calibration degree. The decision curve showed that these models have good clinical effectiveness. Conclusion The prediction model of CRKP infections based on the above 8 risk factors can be used as a risk prediction tool for clinical identification of CRKP infections.