Clinical characteristics and drug resistance of <i>Klebsiella pneumoniae</i> in patients with nosocomial and community infections in Quanzhou, China_Chinese Journal of Evidence-Based Medicine

Authors：

 CHEN Xiarong , LIN Liling , WU Yihai , ZHANG Huaping , ZENG Xiuyu , QIU Xiulan , WENG Yueping

Department of Hospital-Acquired Infection Control, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, P.R.China;

Corresponding?author：

CHEN Xiarong, Email: fjmucxr@126.com

Keywords：

Klebsiella pneumonia; Extended-spectrum beta-lactamase (ESBL); Nosocomial infection; Community infection; Distribution; Drug resistance rate

DOI：

10.7507/1672-2531.201812098

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Objective To compare the clinical characteristics of patients with nosocomial and community infections with extended-spectrum beta-lactamase-containing Klebsiella pneumoniae (ESBL-KP) and non-ESBL-KP so as to improve clinical diagnosis and treatment outcomes.Methods This retrospective study determined the clinical features of patients with nosocomial and community infections with KP who were admitted to our hospital from January 1^st, 2017 to June 30^th, 2018. The chi-square test or Fisher's exact probability method were used to compare different groups.Results We identified 334 strains of KP, and 83 (24.9%) of them strains were EBSL-KP. The percentages of ESBL-KP infections among those with nosocomial and community infections were similar (31.25% vs. 22.27%, χ²=2.955, P=0.086). Significantly more females than males had ESBL-KP infections (32.32 vs. 21.70%, χ²=4.208, P=0.040). The percentages of ESBL-KP infections were similar among <18 years-old group, 18 to 45 years-old group, 45 to 60 years-old group, and ≥60 years-old group. The three major locations of KP infections were the lower respiratory tract, urinary tract, and bloodstream (bacteremia). Among nosocomial KP infections, there were no significant differences in the percentages of ESBL-KP infections at different sites, nor in the hospital departments where patients were treated; among community KP infections, there were significant differences in the percentages of ESBLs-KP infections at different sites, and in the hospital departments where patients were treated. For community KP infections, the two most common infection sites were the urinary tract (37.74%) and the skin and soft tissue (30.77%), and most patients were treated in the urology department (40.00%) and respiratory medicine department (38.10%). ESBL-KP isolates had greater resistance than non-EBSL-KP isolates to 16 tested antibiotics (P<0.05). There were no statistically significant differences in the percentages of nosocomial infections and community infections among those with ESBL-KP and among those with non-ESBL-KP (P>0.05).Conclusions Our population have high rates of nosocomial and community KP infections and of infections with ESBL-KP. It is necessary to strengthen the management and clinical use of antibiotics and to provide real-time surveillance of KP infections, especially for patients with ESBL-KP infections. Increased vigilance is required for KP infections of females and community KP infections to improve control of nosocomial infections and reduce the prevalence of cross-infections.

Citation： CHEN Xiarong, LIN Liling, WU Yihai, ZHANG Huaping, ZENG Xiuyu, QIU Xiulan, WENG Yueping. Clinical characteristics and drug resistance of Klebsiella pneumoniae in patients with nosocomial and community infections in Quanzhou, China. Chinese Journal of Evidence-Based Medicine, 2019, 19(9): 1018-1023. doi: 10.7507/1672-2531.201812098 Copy

1.	張前進, 孫德明, 謝志強, 等. 肺炎克雷伯菌的臨床感染特點及耐藥性分析. 中華醫院感染學雜志, 2014, 24(13): 3137-3138, 3141.
2.	查翔遠, 宋有良, 林建, 等. 肺炎克雷伯菌血流感染的臨床分布及耐藥性分析. 安徽醫學, 2015, (1): 71-74.
3.	季淑娟, 顧怡明, 譚文濤, 等. 中國部分地區大腸埃希菌和肺炎克雷伯菌超廣譜 β 內酰胺酶基因型研究. 中華檢驗醫學雜志, 2004, 27(9): 590-593.
4.	Woodford NL, Tierno PMJ, Young K, et al. Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A beta-lactamase, KPC-3, in a New York medical center. Antimicrob Agents Chemother, 2004, 48(12): 4793-4799.
5.	Keynan Y, Rubinstein E. The changing face of Klebsiella pneumoniae infections in the community. Int J Antimicrob Agents, 2007, 30(5): 385-389.
6.	凌勇, 肖洪廣, 邱芳華. 耐碳青霉烯肺炎克雷伯菌的耐藥基因分析. 熱帶醫學雜志, 2018, 18(3): 358-361.
7.	胡付品, 郭燕, 朱德妹, 等. 2017 年 CHINET 中國細菌耐藥性監測. 中國感染與化療雜志, 2018, 18(3): 241-251.
8.	何足元, 陳志敏. 醫院內感染和社區感染兒童肺炎克雷伯桿菌臨床特點及耐藥性分析. 重慶醫學, 2013, (36): 4382-4384.
9.	趙玉杰, 王麗, 呂艷關. 2015-2017 年某院產超廣譜 β 內酰胺酶大腸埃希菌耐藥性及其所致感染性疾病的危險因素分析. 現代醫藥衛生, 2018, 34(21): 3315-3317.
10.	Meier S, Weber R, Zbinden R, et al. Extended-spectrum beta-lactamase-producing gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy. Infection, 2011, 39(4): 333-340.
11.	黃艷飛, 張嘉琦. ESBL 陽性肺炎克雷伯菌所致肺炎臨床特點和耐藥性分析. 標記免疫分析與臨床, 2018, 25(7): 929-934.
12.	吳雪花, 陳林俊, 徐華. 外科手術部位感染常見病原菌及其耐藥性分析. 現代實用醫學, 2014, 26(10): 1308-1309.
13.	馬利. 某院大腸埃希菌與肺炎克雷伯菌感染的臨床特征及耐藥分析. 臨床醫學研究與實踐, 2018, 3(11): 99-100, 113.
14.	Boix-Palop L, Xercavins M, Badia C, et al. Emerging extended-spectrum β-lactamase-producing Klebsiella pneumoniae causing community-onset urinary tract infections: a case-control-control study. Antimicrob Agents, 2017, 50(2): 197-202.
15.	高玉紅, 毛曉琴, 平竹仙. 尿路感染產超廣譜 β 內酰胺酶大腸埃希菌和肺炎克雷伯菌耐藥特征分析. 重慶醫學, 2016, (3): 393-394.
16.	曾秀玉, 張華平, 陳夏容, 等. 主動干預對重癥監護病房醫院感染的防控效果研究. 中國循證醫學雜志, 2016, 16(6): 641-645.
17.	熊凱, 史瑀. 肺炎克雷伯菌致社區感染和醫院感染的耐藥性調查. 中國現代醫生, 2018, 56(8): 122-124, 133.
18.	賀曉珊, 梅傳忠. 肺炎克雷伯菌耐藥機制的研究進展. 西部醫學, 2014, 26(1): 124-126.
19.	陳夏容, 張華平, 曾秀玉, 等. 社區產 ESBLs 大腸埃希菌泌尿系感染的危險因素分析. 中國循證醫學雜志, 2016, 16(2): 125-129.
20.	孫長貴, 陳漢美. 超廣譜 β-內酰胺酶研究進展. 國外醫藥(抗生素分冊), 2000, 21(3): 111-115.
21.	王惠姣, 徐嬌君, 陳小平, 等. ICU 患者感染多藥耐藥肺炎克雷伯菌的耐藥性分析. 中華醫院感染學雜志, 2016, 26(6): 1235-1237, 1240.

1. 張前進, 孫德明, 謝志強, 等. 肺炎克雷伯菌的臨床感染特點及耐藥性分析. 中華醫院感染學雜志, 2014, 24(13): 3137-3138, 3141.
2. 查翔遠, 宋有良, 林建, 等. 肺炎克雷伯菌血流感染的臨床分布及耐藥性分析. 安徽醫學, 2015, (1): 71-74.
3. 季淑娟, 顧怡明, 譚文濤, 等. 中國部分地區大腸埃希菌和肺炎克雷伯菌超廣譜 β 內酰胺酶基因型研究. 中華檢驗醫學雜志, 2004, 27(9): 590-593.
4. Woodford NL, Tierno PMJ, Young K, et al. Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A beta-lactamase, KPC-3, in a New York medical center. Antimicrob Agents Chemother, 2004, 48(12): 4793-4799.
5. Keynan Y, Rubinstein E. The changing face of Klebsiella pneumoniae infections in the community. Int J Antimicrob Agents, 2007, 30(5): 385-389.
6. 凌勇, 肖洪廣, 邱芳華. 耐碳青霉烯肺炎克雷伯菌的耐藥基因分析. 熱帶醫學雜志, 2018, 18(3): 358-361.
7. 胡付品, 郭燕, 朱德妹, 等. 2017 年 CHINET 中國細菌耐藥性監測. 中國感染與化療雜志, 2018, 18(3): 241-251.
8. 何足元, 陳志敏. 醫院內感染和社區感染兒童肺炎克雷伯桿菌臨床特點及耐藥性分析. 重慶醫學, 2013, (36): 4382-4384.
9. 趙玉杰, 王麗, 呂艷關. 2015-2017 年某院產超廣譜 β 內酰胺酶大腸埃希菌耐藥性及其所致感染性疾病的危險因素分析. 現代醫藥衛生, 2018, 34(21): 3315-3317.
10. Meier S, Weber R, Zbinden R, et al. Extended-spectrum beta-lactamase-producing gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy. Infection, 2011, 39(4): 333-340.
11. 黃艷飛, 張嘉琦. ESBL 陽性肺炎克雷伯菌所致肺炎臨床特點和耐藥性分析. 標記免疫分析與臨床, 2018, 25(7): 929-934.
12. 吳雪花, 陳林俊, 徐華. 外科手術部位感染常見病原菌及其耐藥性分析. 現代實用醫學, 2014, 26(10): 1308-1309.
13. 馬利. 某院大腸埃希菌與肺炎克雷伯菌感染的臨床特征及耐藥分析. 臨床醫學研究與實踐, 2018, 3(11): 99-100, 113.
14. Boix-Palop L, Xercavins M, Badia C, et al. Emerging extended-spectrum β-lactamase-producing Klebsiella pneumoniae causing community-onset urinary tract infections: a case-control-control study. Antimicrob Agents, 2017, 50(2): 197-202.
15. 高玉紅, 毛曉琴, 平竹仙. 尿路感染產超廣譜 β 內酰胺酶大腸埃希菌和肺炎克雷伯菌耐藥特征分析. 重慶醫學, 2016, (3): 393-394.
16. 曾秀玉, 張華平, 陳夏容, 等. 主動干預對重癥監護病房醫院感染的防控效果研究. 中國循證醫學雜志, 2016, 16(6): 641-645.
17. 熊凱, 史瑀. 肺炎克雷伯菌致社區感染和醫院感染的耐藥性調查. 中國現代醫生, 2018, 56(8): 122-124, 133.
18. 賀曉珊, 梅傳忠. 肺炎克雷伯菌耐藥機制的研究進展. 西部醫學, 2014, 26(1): 124-126.
19. 陳夏容, 張華平, 曾秀玉, 等. 社區產 ESBLs 大腸埃希菌泌尿系感染的危險因素分析. 中國循證醫學雜志, 2016, 16(2): 125-129.
20. 孫長貴, 陳漢美. 超廣譜 β-內酰胺酶研究進展. 國外醫藥(抗生素分冊), 2000, 21(3): 111-115.
21. 王惠姣, 徐嬌君, 陳小平, 等. ICU 患者感染多藥耐藥肺炎克雷伯菌的耐藥性分析. 中華醫院感染學雜志, 2016, 26(6): 1235-1237, 1240.

Chinese Journal of Evidence-Based Medicine

Clinical characteristics and drug resistance of Klebsiella pneumoniae in patients with nosocomial and community infections in Quanzhou, China

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