Objective To study the risk factors and prognosis of hospital acquired pneumonia( HAP)caused by carbapenem-resistant Acinetobacter baumannii( CRAB) . Methods By a case-control study, the data of 44 cases of HAP caused by CRAB fromJan 2005 to Dec 2007 in Nanfang Hospital were analyzed. 66 cases of HAP caused by Carbapenem-susceptible A. baumannii ( CSAB) were selected randomly at the same time as control. Univariate analysis( T test and chi-square test) and multivariate logistic regression were used for statistics analysis. Results Univariate analysis revealed that five factors associated with the infection caused by CRAB were APACHE Ⅱ score ≥ 16, chronic pulmonary disease ( COPD/ bronchiectasis ) , imipenem/meropenem and fluoroquinolone used 15 days before isolation of CRAB, and early combination therapy of antibiotics. Multivariate logistic regression analysis identified two independent factors as APACHEⅡ score ≥16( OR=6. 41, 95% CI 2. 20-18. 67) and imipenem/meropenemused 15 days before isolation of CRAB( OR =6. 33,95% CI 1. 83-21. 87) . Of 44 cases of CRAB infections, 14 patients died and 30 patients survived. Univariate analysis revealed that two factors associated with poor prognosis were organ failure and clinical pulmonary infection score( CPIS) rise after three-day treatment. According to multivariate logistic regression analysis, only CPIS rise after three-day treatment ( OR =7. 01, 95% CI 1. 23-40. 03) was an independent predictive factor. Conclusions APACHEⅡ score ≥ 16 and imipenem/meropenem used 15 days before isolation of CRAB were independent risk factors for CRAB infection. CPIS rise after three-day treatment was a predictive factor for the prognosis of CRAB infection.
Objective A comparative study of in-hospital mortality and risk factors of ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria (CRGNB) and non-carbapenem-resistant gram-negative bacteria (nCRGNB) in China was conducted to investigate whether there is a higher in-hospital mortality of VAP caused by CRGNB and its unique associated risk factors. Methods Relevant literatures published at home and abroad in PubMed, EMBASE, Cochrane library, Web of Science, CNKI and Wanfang databases were retrieved from the date of establishment to June 1, 2021, and the quality of the included literatures was evaluated using Newcastle-Ottawa scale. Meta-analysis of literatures meeting the criteria was performed using RevMan 5.3 software. Results A total of 5 literatures were included, all of which were case-control studies with a total of 574 cases, including 302 cases in the CRGNB group and 272 cases in the nCRGNB group. The results showed that the in-patient mortality of VAP caused by CRGNB infection was significantly increased compared with that of VAP caused by nCRGNB infection (OR=2.51, 95%CI 1.71 - 3.67, P<0.00001). Risk factor analysis of CRGNB infection showed that statistically significant risk factors included mechanical ventilation duration ≥7 days (OR=2.66, 95%CI 1.23 - 5.75, P=0.01), secondary intubation (OR=4.48, 95%CI 2.61 - 7.69], P<0.00001), combined with antibiotics (OR=2.83, 95%CI 1.76 - 4.54, P<0.0001), using carbapenem antibiotics (OR=2.78, 95%CI 1.76 - 4.40, P<0.0001). In addition, two studies showed that tigecycline was sensitive to CRGNB in vitro. Conclusions Compared with nCRGNB-induced VAP, CRGNB infection significantly increases the in-hospital mortality of VAP patients in China, indicating that the in-hospital mortality of CRGNB infection is related to drug resistance, and had little relationship with region and drug resistance mechanism. Among them, mechanical ventilation duration ≥7 days, secondary intubation, combined use of antibiotics and carbapenem antibiotics are risk factors for CRGNB infection in VAP patients. Tigecycline is sensitive to most CRGNB strains in China and is an important choice for the treatment of CRGNB in China.
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.
ObjectiveTo evaluate the burden of carbapenem-resistant Klebsiella pneumoniae (CRKPN) and carbapenem-resistant Escherichia coli (CRECO), two types of carbapenem-resistant Enterobacteriaceae (CRE), in pediatric patients in Jiangxi Province.MethodsA retrospective investigation was carried out for the distribution of CRKPN/CRECO in pediatric (neonatal group and non-neonatal group) and adult patients in 30 hospitals in Jiangxi Province from January 2016 to December 2018, and the changing trends and detection situations of different patients and types of hospitals were compared and analyzed.ResultsFrom 2016 to 2018, the annual resistance rates of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients were 5.89%, 4.03%, and 4.24%, respectively, showed a downward trend (χ2trend=5.568, P=0.018). The resistance rate of Klebsiellae pneumoniae and Escherichia coli to carbapenem in neonatal group was higher than that in non-neonatal group (8.44% vs. 3.40%; χ2=63.155, P<0.001) and adult group (8.44% vs. 3.45%; χ2=97.633, P<0.001). In pediatric patients, the 3-year carbapenem resistance rate of Klebsiella pneumoniae was higher than that of Escherichia coli (9.10% vs. 2.48%; χ2=128.177, P<0.001). In non-neonatal pediatric patients, the 3-year resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in maternity and children hospitals was higher than that in general hospitals (4.35% vs. 1.36%; χ2=25.930, P<0.001). CRKPN/CRECO detected in pediatrics were mainly isolated from sputum (31.64%), blood (24.36%), urine (13.82%), and pus (8.36%).ConclusionAlthough the overall resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients showed a downward trend, that in neonatal patients was still high, and the monitoring and prevention and control measures of CRE should be strengthened in neonatal patients.
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.
ObjectiveTo study the direct economic burden of hospitalization in patients with carbapenem-resistant Enterobacteriaceae (CRE) infection.MethodsPatients with CRE detected in Jianyang People’s Hospital between January 2017 and June 2019 were divided into infection group and colonization group, and multiple linear regression analysis was used to analyze the confounding factors, and then propensity score matching method was used to match the confounding factors of the two groups, finally the direct economic burden of hospitalization was compared between the two groups.ResultsA total of 2 013 patients were enrolled, including 507 CRE-infected patients and 1 506 CRE-colonized patients. Multiple linear regression results showed that factors affecting the direct economic burden of hospitalization included mechanical ventilation, intravenous catheterization, blood transfusion or use of blood products, urinary intubation, tracheotomy, gender, surgery, intensive care unit stay, main diagnosis, and the type of medical insurance, together with CRE infection (P<0.05). After propensity score matching, these confounding factors were well balanced between the infection group (n=249) and the colonization group (n=249), and the differences were not statistically significant (P>0.05). The median of total hospitalization cost of CRE-infected patients was 1.29 times (15 589.23 yuan more than) that of CRE-colonized patients and the difference between the two groups was statistically significant (Z=–3.116, P=0.002). The top two types of hospitalization cost with largest differences in the medians were the cost of Western medicine (4 850.21 yuan; Z=–3.460, P=0.001) and the cost of laboratory diagnosis (2 613.00 yuan; Z=–3.529, P<0.001), respectively. The cost of antimicrobial drugs differed significantly between the two groups (Z=–3.391, P=0.001), and it was 1.54 times in patients with CRE infection what it was in patients with CRE colonization.ConclusionsThere are many factors affecting the direct economic burden of inpatients, and it is necessary to avoid the influence of confounding factors as far as possible during analysis. The economic burden of patients with CRE infection is significantly greater than that of CRE-colonized patients, so active measures should be adopted to prevent and control CRE infection.
Objective To analyze the clinical characteristics, mortality risk and risk factors of patients with carbapenem resistant Acinetobacter baumannii (CRAB), so as to provide references for the prevention and control of CRAB. Methods Inpatients with Acinetobacter baumannii were selected from the clinical samples in the intensive care unit of Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital between January 2018 and December 2021. The patients were divided into CRAB infection group, carbapenem-sensitive Acinetobacter baumannii (CSAB) infection group and CRAB colonization group. Survival analysis was used to analyze the mortality risk and its influencing factors in patients with CRAB infection. Results A total of 696 patients were included. Among them, there were 392 cases of CRAB infection, 267 cases of CRAB colonization, and 37 cases of CSAB infection. The factors that increased the 30-day mortality risk of CRAB mainly included blood transfusion or use of blood products, mechanical ventilation, respiratory failure, maximum procalcitonin and age. Kaplan-Meier analysis showed that the 30-day mortality risk of CRAB infection group was higher than that of CSAB infection group（χ2=4.837, P=0.028), there was no significant difference between CRAB infection group and CRAB colonization group in 30-day mortality risk（χ2=0.219, P=0.640). Conclusions The mortality risk of CRAB infected patients is higher. Compared with the infection status, the 30-day mortality risk of patients is more attributed to drug resistance status. The effective method to control the mortality rate of CRAB should focus on reducing the hospital acquisition rate of CRAB.
ObjectiveTo study the antibacterial activity of ceftazidime/avibactam against carbapenem-resistant Klebaiella pneumoniae (CRKP) in vitro and detect the resistance genes of CRKP, so as to provide reference for the treatment of patients with CRKP infection.MethodsA total of 120 CRKP strains isolated from clinical specimens from May 2014 to November 2017 were collected. The activitis of 11 antimicrobial agents against those CRKP strains were detected by broth microdilution method, and the genes related to resistance to ceftazidime/avibactam were detected by polymerase chain reaction in the 120 CRKP isolates.ResultsThe resistance rate of the 120 CRKP isolates against ceftazidime/avibactam was 16.67% (20/120), which was significantly lower than that against cefotaxime (100.00%), aztreonam (98.33%), ceftazidime (95.83%), cefoperazone/sulbactam (95.83%), meropenem (95.83%), imipenem (95.00%), levofloxacin(92.50%), amikacin (54.17%), minocycline (39.17%), and tegacycline (23.33%). Among the 20 CRKP strains resistant to ceftazidime/avibactam, there were 12 Klebsiella pneumoniae carbapenemase (KPC)-2-producing strains, 3 KPC-3-producing strains, 1 New Delhi metallo-β-lactamase-1 (NDM-1)-producing strain, and 1 oxacillin β-lactamase-48-producing strain; none of the 20 strains had KPC mutation.ConclusionsCeftazidime/avibactam is an effective agent agianst CRKP, and its resistance rate is significantly lower than that of other commonly used antimicrobial agents, especially other β-lactam antibiotics. In terms of resistance genes, except for one isolate producing NDM-1, no other known gene resistant to ceftazidime/avibactam has been found.
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.