与多重耐药肺炎克雷伯菌感染相关的危险因素：黎巴嫩医院的一项多中心观察性研究。

Risk factors associated with multidrug-resistant Klebsiella pneumoniae infections: a multicenter observational study in Lebanese hospitals.

机构信息

Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon.

Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia.

出版信息

BMC Public Health. 2024 Oct 25;24(1):2958. doi: 10.1186/s12889-024-20474-0.

DOI:10.1186/s12889-024-20474-0

PMID:39449026

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11515809/

Abstract

BACKGROUND

Klebsiella pneumoniae is a significant global public health burden, especially in low-income countries and regions with fragile healthcare infrastructures, due to its ability to cause severe infections, increase mortality rates, and its rising antimicrobial resistance. This study aimed to estimate the proportion of multidrug-resistant (MDR) K. pneumoniae infections and identify associated risk factors.

METHODS

Data were retrospectively collected from three academic hospitals in Beirut, Lebanon, between January 2021 and September 2023 using a standardized form. Binary logistic regression was used to determine risk factors associated with MDR, extended-spectrum beta-lactamase (ESBL)-producing, and carbapenem-resistant K. pneumoniae (CRKP) infections.

RESULTS

Out of 2,655 K. pneumoniae cases, 410 met the inclusion criteria. The primary infection sources were the urinary tract (58.3%) and the respiratory tract (12.4%). Among the isolates, 61% were MDR K. pneumoniae, with 7.3% being extensively drug-resistant, and 0.5% pandrug-resistant. Additionally, 36.8% were ESBL-producing, while 6.3% were CRKP. Predictors significantly associated with MDR K. pneumoniae infections included male sex (adjusted odds ratio [AOR] = 3.46, 95% CI = 1.01-11.86, P = 0.04), recent antibiotics use (AOR = 4.52, 95% CI = 1.65-12.36, P = 0.003), and recent cancer chemotherapy (AOR = 3.43, 95% CI = 1.25-9.42, P = 0.01). ESBL-producing infections were associated with age ≥ 65 years, higher Charlson Comorbidity Index (CCI), and recent antibiotic use. CRKP infections were linked to male sex, prior antibiotic use, and longer hospital stays prior to infection (all P < 0.05).

CONCLUSIONS

MDR K. pneumoniae infections are steadily rising in Lebanon, along with an increase in ESBL-producing and CRKP cases. The main risk factors for MDR K. pneumoniae infections were male sex, recent antibiotic use, and cancer chemotherapy. ESBL-producing infections were associated with advanced age, higher CCI, and recent antibiotic use, while CRKP infections were linked to male sex, prior antibiotic use, and prolonged hospital stays. This situation is further exacerbated by inadequate healthcare infrastructure and suboptimal national surveillance. Strengthening local surveillance and implementing effective antibiotic stewardship programs are critical to managing this growing threat..

摘要

背景

由于能够引起严重感染、增加死亡率以及其不断上升的抗药性，肺炎克雷伯菌在全球范围内，特别是在医疗保健基础设施脆弱的低收入国家和地区，构成了重大的公共卫生负担。本研究旨在估计多药耐药（MDR）肺炎克雷伯菌感染的比例，并确定相关的危险因素。

方法

本研究使用标准化表格，从 2021 年 1 月至 2023 年 9 月期间，在黎巴嫩贝鲁特的三家学术医院中进行了回顾性数据收集。采用二元逻辑回归分析确定与 MDR、产超广谱β-内酰胺酶（ESBL）和碳青霉烯类耐药肺炎克雷伯菌（CRKP）感染相关的危险因素。

结果

在 2655 例肺炎克雷伯菌病例中，有 410 例符合纳入标准。主要感染源为泌尿道（58.3%）和呼吸道（12.4%）。在分离株中，61%为 MDR 肺炎克雷伯菌，其中 7.3%为广泛耐药，0.5%为泛耐药。此外，36.8%为产 ESBL，6.3%为 CRKP。与 MDR 肺炎克雷伯菌感染显著相关的预测因素包括男性（调整后的优势比 [AOR] = 3.46，95%置信区间 [CI] = 1.01-11.86，P = 0.04）、近期抗生素使用（AOR = 4.52，95% CI = 1.65-12.36，P = 0.003）和近期癌症化疗（AOR = 3.43，95% CI = 1.25-9.42，P = 0.01）。产 ESBL 感染与年龄≥65 岁、较高的 Charlson 合并症指数（CCI）和近期抗生素使用有关。CRKP 感染与男性、先前抗生素使用和感染前更长的住院时间有关（均 P < 0.05）。

结论

在黎巴嫩，MDR 肺炎克雷伯菌感染呈稳步上升趋势，同时产 ESBL 和 CRKP 病例也有所增加。MDR 肺炎克雷伯菌感染的主要危险因素为男性、近期抗生素使用和癌症化疗。产 ESBL 感染与年龄较大、CCI 较高和近期抗生素使用有关，而 CRKP 感染与男性、先前抗生素使用和较长的住院时间有关。当地医疗保健基础设施不足和国家监测不力进一步加剧了这种情况。加强当地监测并实施有效的抗生素管理计划对于应对这一日益严重的威胁至关重要。