Pan Hongying, Lou Yaling, Zeng Linyan, Wang Li, Zhang Jiajie, Yu Wei, Qiu Yunqing
1 Department of Infectious Diseases, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
2 State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Microb Drug Resist. 2019 Mar;25(2):287-296. doi: 10.1089/mdr.2018.0339. Epub 2019 Feb 27.
The spread of carbapenemase-producing Klebsiella pneumoniae (CPKP) worldwide is a serious problem. This retrospective, matched case-control, parallel study in a tertiary teaching hospital analyzed the microbiological and clinical characteristics of CPKP infection, focusing on the risk factors for carbapenem resistance and patient mortality. The hospital department with the highest incidence of CPKP infections was the intensive care unit. All CPKP strains examined were positive for bla, and 84.8% of CPKP were ST11. Hypervirulent phenotype was identified in 22.7% of the patients with CPKP, with these strains displaying a high incidence of positivity for entB, ybtS, and iutA. Multivariate conditional logistic regression analysis demonstrated that Pitt bacteremia score >4, prior stomach tube, continuous renal replacement therapy (CRRT), and previous carbapenem exposure were associated with CPKP infection. Higher albumin concentration and use of cephalosporins after diagnosis were strong prognostic factors for crude 28-day mortality. Further, high APACHE II score, CRRT, use of carbapenems after diagnosis, and bacteremia were risk factors for crude in-hospital mortality. CPKP isolates showed clonal spread and were resistant to most antibiotics, resulting in higher financial burden. Critical illness was associated with increased mortality.
产碳青霉烯酶肺炎克雷伯菌（CPKP）在全球范围内的传播是一个严重问题。这项在一家三级教学医院开展的回顾性、匹配病例对照平行研究分析了CPKP感染的微生物学和临床特征，重点关注碳青霉烯耐药和患者死亡的危险因素。CPKP感染发生率最高的医院科室是重症监护病房。所有检测的CPKP菌株bla均呈阳性，84.8%的CPKP为ST11型。22.7%的CPKP患者被鉴定为高毒力表型，这些菌株entB、ybtS和iutA的阳性率较高。多因素条件logistic回归分析表明，皮特菌血症评分>4、既往使用胃管、持续肾脏替代疗法（CRRT）以及既往碳青霉烯暴露与CPKP感染相关。诊断后较高的白蛋白浓度和头孢菌素的使用是28天粗死亡率的有力预后因素。此外，高急性生理与慢性健康状况评分系统II（APACHE II）评分、CRRT、诊断后碳青霉烯类药物的使用以及菌血症是院内粗死亡率的危险因素。CPKP分离株呈现克隆传播，对大多数抗生素耐药，导致更高的经济负担。危重病与死亡率增加相关。
