OBJECTIVE To analyze the trends in drug resistance of Klebsiella pneumoniae (KP) in a three-A hospital from 2018 to 2024, investigate the epidemiological characteristics of carbapenem-resistant K. pneumoniae (CRKP) and evaluate the effectiveness of comprehensive intervention measures, thereby providing a basis for optimizing prevention and control strategies.

METHODS Data on KP strains clinically isolated from Qingdao Municipal Hospital from Jan. 2018 to Dec. 2024 were retrospectively collected. The departmental sources, specimen distributions and changes in drug resistance rates were analyzed. A bundle of comprehensive interventions, including active screening, contact isolation, hand hygiene promotion and antimicrobial stewardship (AMS), was implemented and progressively strengthened beginning since 2020.

RESULTS A total of 10 343 KP strains were isolated, with an overall detection rate of CRKP 13.80%. The total detection rate of CRKP from 2022 to 2024 (12.39%) decreased compared to that from 2018 to 2021 (15.98%) (P < 0.001). The detection rates of CRKP in the surgical, medical and intensive care units (ICU) all showed a decreasing trend. However, the detection rate of CRKP in the emergency department increased against the trend (from 17.05% to 23.53%, P=0.014). The detection rate of CRKP acquired outside the hospital was positively correlated with that of hospital-acquired CRKP (P=0.010). The resistance rates of KP to most antimicrobial agents increased, but the resistance rates to tigecycline and polymyxin remained low.

CONCLUSIONS Comprehensive interventions achieved preliminary success in controlling CRKP transmission in ICUs. However, the emergency department has emerged as a critical hub for CRKP introduction and spread. Future strategies should be advanced upstream, establishing a three-tier network of "pre-hospital screening-emergency triage-ward-specific precision prevention". Continuous strengthening of AMS remains essential to effectively curb the spread of CRKP.