TY - JOUR

T1 - Longitudinal Study of the Drug Resistance in Klebsiella pneumoniae of a Tertiary Hospital, China

T2 - Phenotypic Epidemiology Analysis (2013-2018)

AU - Pei, Na

AU - Liu, Qingxia

AU - Cheng, Xinyi

AU - Liang, Tianzhu

AU - Jian, Zijuan

AU - Wang, Siyi

AU - Zhong, Yiming

AU - He, Jingxuan

AU - Zhou, Mao

AU - Kristiansen, Karsten

AU - Chen, Weijun

AU - Liu, Wenen

AU - Li, Junhua

PY - 2021

Y1 - 2021

N2 - Purpose: Multi-drug resistant Klebsiella pneumoniae (MDR KP) is spreading worldwide and has posed a huge medical burden to public health. However, studies on drug resistance surveillance of KP, especially MDR KP, with a large longitudinal sample size in a tertiary hospital are rare. This study aims to investigate phenotypic epidemiology characteristics of 4128 KP isolates in a Chinese tertiary hospital covering a period of 5 years.Methods: All the KP clinical isolates were retrospectively collected from a tertiary hospital in Hunan province of China from Jan 5, 2013 to Jul 24, 2018. All the isolates were identified by MALDI-TOF MS analysis. Twenty-four antimicrobial agents were tested by antimicrobial susceptibility testing. Fisher exact test and logistic regression were used to analyze the association between clinical factors and antimicrobial non-susceptibility for seven secondchoice antimicrobials.Results: A total of 4128 KP isolates were collected in our study. The non-susceptible rates (NSRs) to ertapenem, imipenem and tigecycline increased considerably from 2013 to 2018 (13.6% to 28.6%, 10.1% to 28.9%, 10.8% to 46.5%, respectively) Amikacin presents the lowest NSR among 3 aminoglycosides (3.8-22.8%). The multi-drug NSRs among KP isolates to second-choice antimicrobials (88.6-100%) were higher than to all drugs (68.0%). The NSRs varied significantly among departments and sample sources. Higher ETP/IPM/AK NSRs (39.8/39.7/30.6%) were observed in Intensive Care Unit, and ETP/IPM non-susceptible isolates tended to distribute in cerebrospinal fluid. From 2015 to 2017, the NSRs of ETP, IPM, and AK showed an opposite trend of seasonal fluctuations to SXT.Conclusion: Higher multi-drug resistance (MDR) rates were observed in KP isolates to second-choice antimicrobials than to others, among which MDR rates to carbapenems or AK are the highest. A unique pattern of MX and time distributions of MDR were observed. Clinical factors including gender were correlated with MDR rates of KP. Isolates in ICU and CSF showed higher NSRs in carbapenems which should be paid more attention to, and temporal distribution of NSRs was observed.

AB - Purpose: Multi-drug resistant Klebsiella pneumoniae (MDR KP) is spreading worldwide and has posed a huge medical burden to public health. However, studies on drug resistance surveillance of KP, especially MDR KP, with a large longitudinal sample size in a tertiary hospital are rare. This study aims to investigate phenotypic epidemiology characteristics of 4128 KP isolates in a Chinese tertiary hospital covering a period of 5 years.Methods: All the KP clinical isolates were retrospectively collected from a tertiary hospital in Hunan province of China from Jan 5, 2013 to Jul 24, 2018. All the isolates were identified by MALDI-TOF MS analysis. Twenty-four antimicrobial agents were tested by antimicrobial susceptibility testing. Fisher exact test and logistic regression were used to analyze the association between clinical factors and antimicrobial non-susceptibility for seven secondchoice antimicrobials.Results: A total of 4128 KP isolates were collected in our study. The non-susceptible rates (NSRs) to ertapenem, imipenem and tigecycline increased considerably from 2013 to 2018 (13.6% to 28.6%, 10.1% to 28.9%, 10.8% to 46.5%, respectively) Amikacin presents the lowest NSR among 3 aminoglycosides (3.8-22.8%). The multi-drug NSRs among KP isolates to second-choice antimicrobials (88.6-100%) were higher than to all drugs (68.0%). The NSRs varied significantly among departments and sample sources. Higher ETP/IPM/AK NSRs (39.8/39.7/30.6%) were observed in Intensive Care Unit, and ETP/IPM non-susceptible isolates tended to distribute in cerebrospinal fluid. From 2015 to 2017, the NSRs of ETP, IPM, and AK showed an opposite trend of seasonal fluctuations to SXT.Conclusion: Higher multi-drug resistance (MDR) rates were observed in KP isolates to second-choice antimicrobials than to others, among which MDR rates to carbapenems or AK are the highest. A unique pattern of MX and time distributions of MDR were observed. Clinical factors including gender were correlated with MDR rates of KP. Isolates in ICU and CSF showed higher NSRs in carbapenems which should be paid more attention to, and temporal distribution of NSRs was observed.

KW - Klebsiella pneumoniae

KW - drug resistance

KW - NSR

KW - phenotypic epidemiology

KW - ANTIMICROBIAL RESISTANCE

KW - RISK-FACTORS

KW - INFECTION

KW - COLISTIN

KW - THREAT

U2 - 10.2147/IDR.S294989

DO - 10.2147/IDR.S294989

M3 - Journal article

C2 - 33628037

VL - 14

SP - 613

EP - 626

JO - Infection and Drug Resistance

JF - Infection and Drug Resistance

SN - 1178-6973

ER -