Objective To investigate the risk factors for Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections, and construct a clinical model for predicting the risk of CRKP infections. Methods A retrospective analysis was performed on Klebsiella pneumoniae infection patients hospitalized in the Third Hospital of Hebei Medical University from May 2020 to May 2021. The patients were divided into a CRKP group (117 cases) and a Carbapenem-sensitive Klebsiella pneumoniae (CSKP) group (191 cases). The predictors were screened by full subset regression using R software (version 4.3.1). The truncation values of continuous data were determined by Youden index. Nomogram and score table model for CRKP infections risk prediction was constructed based on binary logistic regression. The receiver operator characteristic (ROC) curve and area under curve (AUC) were used to evaluate the accuracy of models. Calibration curve and decision curve were used to evaluate the performance of models. Results308 patients with Klebsiella pneumoniae infections were included. A total of 8 predictors were selected by using full subset regression and truncation values were determined according to Youden index: intensive care unit (ICU) stay at time of infection>2 days, male, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score>15 points, hospitalization stay at time of infection>10 days, any history of Gram-negative bacteria infection in the last 6 months, heart disease, lung infection, antibiotic exposure history in the last 6 months. The AUC of CRKP prediction risk curve model was 0.811 (95%CI 0.761 - 0.860). When the optimal cut-off value of the constructed CRKP prediction risk rating table was 6 points, the AUC was 0.723 (95%CI 0.672 - 0.774). The Bootstrap method was used for internal repeated sampling for 1000 times for verification. The model calibration curve and Hosmer-Lemeshow test (P=0.618) showed that these models have good calibration degree. The decision curve showed that these models have good clinical effectiveness. Conclusion The prediction model of CRKP infections based on the above 8 risk factors can be used as a risk prediction tool for clinical identification of CRKP infections.
ObjectiveTo evaluate the burden of carbapenem-resistant Klebsiella pneumoniae (CRKPN) and carbapenem-resistant Escherichia coli (CRECO), two types of carbapenem-resistant Enterobacteriaceae (CRE), in pediatric patients in Jiangxi Province.MethodsA retrospective investigation was carried out for the distribution of CRKPN/CRECO in pediatric (neonatal group and non-neonatal group) and adult patients in 30 hospitals in Jiangxi Province from January 2016 to December 2018, and the changing trends and detection situations of different patients and types of hospitals were compared and analyzed.ResultsFrom 2016 to 2018, the annual resistance rates of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients were 5.89%, 4.03%, and 4.24%, respectively, showed a downward trend (χ2trend=5.568, P=0.018). The resistance rate of Klebsiellae pneumoniae and Escherichia coli to carbapenem in neonatal group was higher than that in non-neonatal group (8.44% vs. 3.40%; χ2=63.155, P<0.001) and adult group (8.44% vs. 3.45%; χ2=97.633, P<0.001). In pediatric patients, the 3-year carbapenem resistance rate of Klebsiella pneumoniae was higher than that of Escherichia coli (9.10% vs. 2.48%; χ2=128.177, P<0.001). In non-neonatal pediatric patients, the 3-year resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in maternity and children hospitals was higher than that in general hospitals (4.35% vs. 1.36%; χ2=25.930, P<0.001). CRKPN/CRECO detected in pediatrics were mainly isolated from sputum (31.64%), blood (24.36%), urine (13.82%), and pus (8.36%).ConclusionAlthough the overall resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients showed a downward trend, that in neonatal patients was still high, and the monitoring and prevention and control measures of CRE should be strengthened in neonatal patients.
Objective To investigate the clinical characteristics and bacterial drug resistance of bloodstream infection of gram-negative bacteria, and provide guidance for clinical rational drug use and control of hospital infection. Methods A retrospective analysis was conducted in the patients diagnosed as severe pneumonia with blood culture of gram-negative bacteria from January 2015 to December 2017 in Beijing Anzhen Hospital. Results A total of 60 severe pneumonia patients suffered from bloodstream infection of gram-negative bacteria were recruited including 34 males and 26 females aging from 42 to 89 years and 73.4 years in average. In the 60 patients, 32 cases were infected with Klebsiella pneumonias, 20 cases were infected with Acinetobacter baumanni, and 8 cases were infected with Escherichia coli. The antimicrobial susceptibility testing result of Klebsiella pneumonias showed that the drug susceptibility rate was 100% to tigecycline, and 6.3% to amikacin. Escherichia coli was sensitive to Amikacin, imipenem, ceftazidime and meropenem while resistance to other drugs. The antimicrobial resistance of Acinetobacter baumanni was 28.6% for cefoperazone/sulbactam, and 14.3% for tigecycline. C-reactive protein, procalcitonin and SOFA scores were higher in the patients infected with Acinetobacter baumanni. Neutrophils and blood lactic acid were higher in the patients infected with Klebsiella pneumonias. There were no statistical differences in white blood cell, platelet or motality rate between the patients infected with Acinetobacter baumanni and the patients infected with Klebsiella pneumonias. SOFA scores and blood lactic acid had significantly statistical relevance with prognosis. Conclusion There is a high proportion of drug resistance of Klebsiella pneumoniae and Acinetobacter baumanni in the bloodstream infection of gram-negative bacteria.
Objective To explore the clinical manifestations, computed tomography features, management and prognosis of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Methods The clinical data of patients with Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism admitted to Dongnan Hospital of Xiamen University from January 2012 to January 2017 were retrospectively analyzed. Results There were 8 patients who had Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Fever occurred in all patients, respiratory symptoms were noted in 5 patients, abdominal pain occurred in 2 patients, endophthalmitis coexisted in 1 patient, and diabetes mellitus coexisted in 7 patients, with no chest pain or hemoptysis. In biochemical indexes, procalcitonin increased most obviously. Microbiological studies revealed Klebsiella pneumoniae in 8 patients. Chest CT showed peripheral nodules with or without cavities, peripheral wedge-shaped opacities, a feeding vessel sign, pleural effusion, and infiltrative shadow. One patient finally deteriorated to acute respiratory failure, and died due to acute respiratory distress syndrome and/or septic shock. There was one case of spontaneous discharge. A total of 6 patients were improved and cured. Conclusions The clinical manifestation of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism is unspecific and misdiagnosis rate is relatively high. The major characteristics of chest CT scan include peripheral nodules with or without cavities, peripheral wedge-shaped opacities and a feeding vessel sign. Diagnosis and differential diagnosis can be made based on these features combined with clinical data and primary disease (liver abscess).
Liver transplantation is currently the only effective curative treatment for end-stage liver disease. In recent years, with advancements in liver transplantation surgery and anti-rejection drugs, the incidence of surgical complications and organ rejection has gradually decreased. Conversely, transplant-related infections have increasingly become a major factor affecting the prognosis of transplant recipients. Furthermore, due to the progress in critical life support technologies, the time spent in the donor’s intensive care unit (ICU) has been extended, and post-transplant infections originating from the donor, especially donor-derived infection (DDI), have become one of the primary sources of infection for recipients. Studies have shown that infections in liver transplant recipients are often caused by Gram-negative pathogens, particularly carbapenem-resistant Klebsiella pneumoniae (CRKP), which has now become the leading cause of fatal infections in liver transplant recipients. To reduce the risk of donor-derived infections, it is necessary to strengthen donor screening and evaluation, establish standardized testing processes, and adjust the use strategies of post-transplant anti-infective drugs and immunosuppressants. Monitoring the immune status of recipients is also crucial. Multidisciplinary collaboration and the application of new technologies will be key in future infection prevention and control. To promote the prevention and treatment of CRKP-related donor infections, West China Hospital of Sichuan University, in collaboration with international experiences, has organized relevant experts to develop an expert consensus on the prevention and treatment of CRKP-targeted DDI.
ObjectivesTo detect the admission rate and hospital acquired rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Acinetobacter baumannii (CRAB) of active surveillance in Emergency Intensive Care Unit patients of West China Hospital of Sichuan University, to examine whether rectal colonization of CRKP and CRAB are associated with nosocomial infection, so as to provide a scientific basis for the prevention and control of CRKP and CRAB.MethodsA nested case-control study was conducted between April and September 2018 in Emergency Intensive Care Unit. Rectal swabs were obtained to screen CRAB and CRKP, and the admission rate of colonization was calculated. According to whether infected with CRKP/CRAB, the patients were divided into case group (infection group) and control group (noninfection group) to determine whether colonization of CRKP/CRAB were independent risk factors for nosocomial infection using logistic regression model.ResultsThe admission rate of CRKP and CRAB patients were 4.08% (18/441) and 8.78% (38/433), and the nosocomial infection rate was 3.63% (16/441) and 18.01% (78/433) separately. Multivariate analysis showed that rectal colonization of CRKP [odds ratio=5.438, 95% confidence interval (1.643, 17.999), P=0.006] was an independent risk factor for nosocomial infection. However, there was no statistical correlation between rectal colonization of CRAB and nosocomial infection [odds ratio=1.449, 95% confidence interval (0.714, 2.942), P=0.305].ConclusionsThe rectal colonization rate of CRAB is higher than that of CRKP, but it does not increase the risk of CRAB infection in patients. Rectal colonization of CRKP is an important factor for infection of patients. Therefore, early detection of CRKP through active surveillance and taking control measures can help reduce the risk of its spread in the hospital.
ObjectiveTo retrospectively analyze antibiotic resistance and clinical characteristics of Klebsiella pneumoniae strains for guiding the rational use of antibiotics in the area of the Bai nationality.MethodsThe antibiotic resistance and clinical characteristics of Klebsiella pneumoniae strains were retrospective analyzed, which were isolated from specimens of inpatients in First People’s Hospital of Dali between May 2016 and May 2017.ResultsAmong the 1 342 samples of various kinds of samples, 262 strains of Klebsiella pneumoniae were isolated, with the detection rate of 19.52% (262/1342). Clinical isolated strains were mainly from the new pediatric, intensive care unit, respiratory medicine, pediatrics, and mostly from sputum specimens (78.24%, 205/262). By screening of 22 kinds of antimicrobial agents, all strains had ampicillin resistance (100.00%), while none of these strains had ertapenem resistance. Extended-spectrum β-lactamases (ESBLs) positive strains’ resistance rate was higher than ESBLs negative strains (χ2=261.992, P<0.01). There were 76 drug resistant profiles, most of which were multidrug-resistant bacteria except 116 (44.27%) strains were resistant to ampicillin antibiotics only. And the number of strains in other resistant types ranged from 1 to 16. Only one of 262 strains had amikacin resistance, two of them were resistant to imipenem and meroenan.ConclusionsThere are many multidrug-resistant bacteria in Klebsiella pneumoniae in the population of Bai nationality, and there are no extensively drug resistant bacteria and pandrug-resistant bacteria strains. The strains of carbapene-resistant antibiotics should be worthy of clinical attention.
Objective To compare the screening ability of modified Hodge test (MHT), modified carbapenem inactivation method (mCIM) and EDTA-carbapenem inactivation method (eCIM) for drug resistance phenotype of carbapenemase-producing Klebsiella pneumoniae. MethodsCarbapenem resistant Klebsiella pneumoniae (CRKP) strains clinically isolated from 5 hospitals in Chengdu between January 2019 and December 2021 were collected, and the carbapenem sensitive Klebsiella pneumoniae (CSKP) strains isolated in the same period were randomly collected. Polymerase chain reaction (PCR) -amplified carbapenem resistance gene as the gold standard, the consistencies between the results of the three phenotypic tests and the results of genetic testing were compared. Results A total of 160 CRKP strains and 120 CSKP strains were isolated. Among the 160 CRKP strains, carbapenem resistance genes were detected in 156 strains, including 105 strains of blaKPC-2, 41 strains of blaNDM-1, 8 strains of blaKPC-19, 1 strain of blaIMP-1, and 1 strain carrying both blaKPC-2 and blaNDM-1. None of the 120 CSKP drug resistance genes were detected. The sensitivity and specificity of carbapenem screening for MHT and mCIM were 73.08% (114/156), 96.67% (116/120), 97.44% (152/156) and 98.33% (118/120), respectively. The sensitivity and specificity of eCIM for screening metalloenzymes were 95.35% (41/43) and 100% (120/120), respectively. Conclusions The sensitivity of MHT to detect carbapenemase is lower than that of the other two methods, and it is easy to produce false negatives when it is used to detect metalloenzymes. The mCIM has high sensitivity and is consistent with the PCR genetic test results. The combined detection of mCIM and eCIM can screen carbapenemases more effectively and distinguish the types of carbapenemases.
ObjectiveTo study the distributions of virulence genes of Klebsiella pneumoniae (KP) and the distribution of hypervirulent KP (HvKP), and assess the performance of a single gene to predict HvKP.MethodsPolymerase chain reaction (PCR) method was used to analyze 12 virulence-related genes (entB, irp2, iroN, iucA, mrkD, fimH, c-rmpA, p-rmpA2, p-rmpA, wzy-K1, allS and peg-344) and drug-resistance gene blaKPC among 376 clinical KP strains collected from January 2016 to December 2018. Sequence types (ST) of KP were determined after sequencing and comparison, following the detection of 7 house-keeping genes (gapA, infB, mdh, pgi, phoE, rpoB and tonB) by PCR method. Statistical analyses were made for the distributions of virulence genes of KP and the distribution of HvKP with GraphPad Prism 8 software.ResultsAmong the 376 KP strains, the positive rates of entB, irp2, iroN, iucA, mrkD, fimH, c-rmpA, p-rmpA2, p-rmpA, wzy-K1, allS and peg-344 were 100.0%, 76.9%, 22.1%, 28.2%, 97.6%, 97.1%, 1.6%, 24.5%, 21.0%, 7.4%, 4.8% and 31.6%, respectively. The positive rates of the aforementioned virulence genes in the blaKPC-positive group (n=167) were 100.0%, 94.0%, 7.2%, 16.8%, 97.0%, 96.4%, 0.0%, 15.0%, 6.6%, 0.0%, 0.0% and 21.0%, respectively, and those in the blaKPC-negative group (n=209) were 100.0%, 63.2%, 34.0%, 37.3%, 98.1%, 97.6%, 2.9%, 32.1%, 32.5%, 13.4%, 8.6% and 40.2%, respectively; there was no statistically significant difference in entB, mrkD or fimH between the two groups (P>0.05), the positive rate of irp2 was higher in the blaKPC-positive group than that in the blaKPC-negative group (P<0.05), and the positive rates of the rest virulence-related genes were lower in the blaKPC-positive group than those in the blaKPC-negative group (P<0.05). The rate of HvKP in the blaKPC-negative group was higher than that in the blaKPC-positive group (38.3% vs. 18.0%, P<0.05). As a marker of HvKP, iucA showed high sensitivity and specificity (90.9% and 97.7%), followed by p-rmpA2 (83.6% and 100.0%) and iroN (73.6% and 99.2%). ST11 accounted for 87.4% in the blaKPC-positive group, while ST23, ST20, ST54 and ST29 were the four primary types in the blaKPC-negative group, accounting for 23.4% totally.ConclusionsDifferent virulence genes mean different distributions in KP. blaKPC-negative KP is more virulent than blaKPC-positive KP. iucA and p-rmpA2 could serve as good predicators of HvKP. Armed with extreme virulence and drug-resistance, blaKPC-positive HvKP is of great clinical concern.
ObjectiveTo observe and analyze the clinical features and prognosis of endogenous klebsiella pneumoniae endophthalmitis (EKPE).MethodsThis is a retrospective case series study. Seven patients (8 eyes) with EKPE were enrolled in this study. There were 3 males (4 eyes) and 4 females (4 eyes). The ages were from 39 to 76 years, the mean age was 57.29 years. All these cases had no history of trauma and surgery. Meanwhile, they all had some risk factors, such as infection, diabetes mellitus, systemic lupus erythematosus, liver abscess, renal insufficiency undergoing dialysis treatment, Hodgkin lymphoma and so on. All the eyes were undertaken visual acuity, slit lamp and fundus examination to observe the eye conditions. Seven eyes were undertaken pars plana vitrectomy with intravitreal injection of antibiotics from 2 days to 2 weeks after onset. And only one eye was undertaken intravitreal injection of antibiotics without surgery. Microbial stains and culture were performed for 7 eyes using vitreous and aqueous fluid samples from the procedures of vitrectomy. Meanwhile, culture and drug sensitive tests were performed from blood samples. According to the result of the drug sensitive tests, carbapenems such as imipenem and meropenem were used in each patient through intravenous injection from 1 to 2 weeks. During the follow up period from 3 days to 1 year, prognosis was observed at each office visit.ResultsFrom these eight eyes, presenting visual acuity was light perception (4 eyes), hand motion (3 eyes), 0.1 (1 eye). Hypopyon (6 eyes), aqueous fluid opacity (2 eyes) and diffuse vitreous opacity (8 eyes) were found. Changes in fundus like optic disc, macular edema and retinal vascular occlusion could be observed. Cultures of the vitreous and aqueous fluid samples from vitrectomy were all point out to klebsiella pneumoniae. At last office visit, the visual acuity of patients with hypopyon was no light perception (1 eye), light perception (1 eye), hand motion (1 eye). The visual acuity of patients without hypopyon was 0.05 (1 eye) and 0.5(1 eye). Finally, 1 eye was underwent enucleation and one patient with binocular disease was died of multiple organ failure.ConclusionsEKPE is almost unilateral attacked. Changes in fundus like optic disc, macular edema and retinal vascular occlusion can be observed. EKPE is commonly associated with poor visual outcomes. It is useful to save patients’ visual acuity by performing vitrectomy before hypopyon happened.