Clinical characteristics of patients with hospital-acquired infections caused by carbapenem-resistant gram-negative bacteria and effectiveness of AMS

OBJECTIVE To understand the clinical distribution of carbapenem-resistant gram-negative bacteria (CR-GNB) hospital-acquired infections and observe the effectiveness of antimicrobial stewardship (AMS) so as to provide theoretical basis for targeted supervision.

METHODS The patients who were detected with CR-GNB in the First People′s Hospital of Lianyungang from Jan. 1, 2015 to Dec. 31, 2023 were monitored by hospital-acquired infection informatization monitoring system, the demographic and etiological data were collected from the patients with hospital-acquired infections, the clinical characteristics were analyzed. The incidence of CR-GNB infections, isolation rates and drug administration indexes were observed and compared, and the effectiveness of AMS was evaluated.

RESULTS A total of 972 633 hospitalized patients were monitored, 1319 of whom had hospital-associated CR-GNB infections, and the total incidence of infections was 0.17%, showing a continuously downward trend during the years(P < 0.001). Carbapenem-resistant Acinetobacter baumannii (43.37%), carbapenem-resistant Pseudomonas aeruginosa (29.72%) and carbapenem-resistant Klebsiella pneumoniae (24.94%) ranked the top 3 species of pathogens. The CR-GNB infections were most prevalent in intensive care unit (ICU), followed by geriatrics department and neurosurgery department. Lower respiratory tract was the predominant infection site. The patients of male, no less than 65 years of age, and ICU stay were at higher risk of CR-GNB infections than other populations(P < 0.001). The implementation of AMS reduced the incidence of CR-GNB infections, isolation rates, utilization rates of antibiotics, antibiotics prophylaxis rates for type Ⅰ incision surgery and antibiotics use density (P < 0.05).

CONCLUSIONS The hospital-associated CR-GNB infection show "U" type epidemiological characteristics. It is necessary to focus on the population characterized by male/the elderly/ICU stay. The implementation of AMS may effectively facilitate the control and detection rate of the CR-GNB infections.