OBJECTIVE  To investigate the clinical characteristics, drug resistance, and risk factors for hospital-associated infections of carbapenem-resistant Klebsiella pneumoniae （CRKP）.

METHODS  We retrospectively collected 152 patients infected with CRKP strains and 1 023 patients infected with carbapenem-sensitive K. pneumoniae （CSKP） at Shanghai First People's Hospital from Jan. 2022 to Dec. 2023. The general conditions, specimen types, departmental sources and drug resistance of the patients were analyzed. A total of 60 hospitalized patients with hospital-associated CRKP infections were selected as the study group, and 294 hospitalized patients with hospital-associated CSKP infections were selected as the control group. Clinical data from both groups were collected, and logistic regression analysis was employed to summarize the risk factors for CRKP infections.

RESULTS  The detection rates of CRKP in 2022 and 2023 were 11.75% and 13.67%, respectively, showing an upward trend. Both the CRKP and CSKP groups predominantly consisted of males, with an average age of （67.52±16.02） years. The main specimen types for CRKP strain infections were respiratory specimens such as sputum （45.39%）, urine （34.21%） and blood （8.55%）. CRKP strains were primarily isolated from the general intensive care unit （ICU） （29.61%）, emergency ward （13.82%）, emergency department （12.50%） and geriatric ward （7.24%）. The drug resistance rates of CRKP strains were higher than those of CSKP strains, with resistance rates exceeding 90% for quinolones, penicillins, cephalosporins and compound preparations of penicillins or cephalosporins with β-lactamase inhibitors, demonstrating multidrug resistance. The resistance rate to amikacin, was less than 65%. CRKP strains were relatively sensitive to colistin and tigecycline, with resistance rates below 5%. The age ＞65 years, hemoglobin ＜80 g/L, hypoalbuminemia and the use of more than two types of antimicrobial agents during hospitalization were risk factors for CRKP infections.

CONCLUSIONS  Hospital-associated CRKP infections have shown an upward trend in the past two years, predominantly affecting elderly, males and patients in the ICU, with high resistance rates to common antimicrobial agents. Therefore, targeted measures can be taken based on the clinical distribution characteristics, drug resistance rates and risk factors of CRKP to help control its spread and reduce the incidence of hospital-associated infections.