OBJECTIVE To observe the detection and drug resistance of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains causing hospital-acquired infections (HAI) and community-acquired infections (CAI) in recent years so as to provide bases for prevention and control of CRKP infection and reasonable clinical use of antibiotics.
METHODS A total of 3444 patients who were diagnosed with Klebsiella pneumonia infection and were hospitalized in the 2nd Affiliated Hospital of Fujian Medical University from Jan. 1, 2017 to Dec. 31, 2023 were recruited as the research subjects. Totally 230 patients with CRKP infection were chosen based on the result of drug susceptibility testing, 73 of whom had HAI, and 157 had CAI. The isolation rate of CRKP strains, population distribution, specimens sources and drug resistance rates were observed and compared between the patients with HAI and the patients with CAI.
RESULTS The total isolation rate of CRKP strains was 6.68 %(230/3444). There was no difference in the sex of the patients with CRKP infection between the HAI patients and the CAI patients, however, the isolation rate of the CRKP strains from the patients aged between 18 and 45 years old was higher in the HAI group than in the CAI group (P < 0.05). The isolation rates of CRKP strains causing the two types of infections increased year by year, showing a remarkable increasing amplitude in 2022-2023, with the HAI increasing from 9.33% to 20.67%, the CAI increasing from 5.54% to 15.03%. The lower respiratory tract, urinary tract and bacteremia were the most common infection sites, the detection rate of soft tissue infections was higher among the patients with HAI than among the patients with CAI (P=0.047). CRKP strains causing HAI showed the highest isolation rate (33.33%) in catheter specimens, and the isolation rate of CRKP strains in pus specimens was higher among the HAI patients than among the CAI patients (P=0.011). The isolation rate of CRKP strains in sputum specimens of the CAI patients raised four times in 2023 as compared with that in 2022. The drug resistance rates of the CRKP strains to 25 types of antibiotics were relatively high and showed upward trends; the drug resistance rate of the HAI-KPN strains to imipenem was 48.78%, higher than 7.09% of the CAI-KPN strains (P < 0.001), and there were no significant differences in the drug resistance rates to other carbapenems between the CAI-KPN strains and the HAI-KPN strains.
CONCLUSIONS The isolation rates of the CRKP strains causing the HAI and CAI are increasing year by year. The clinical invasive procedures and community-acquired respiratory tract infections are the key points for prevention and control. It is necessary to intensify the hospital-community cooperative prevention and control system based on the isolation rates and drug resistance rates of the CRKP strains, and take comprehensive prevention and control measures so as to curb the transmission of the drug-resistant strains.
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