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Objective To investigate a suspected outbreak of carbapenem-resistant Klebsiella pneumoniae(CRKP)healthcare-associated bloodstream infection(HA-BSI),provide reference for effective control of CRKP in-fection.Methods The characteristics of CRKP infected patients and the risk factors for the event transmission in an adult hematology department of a teaching hospital in June 2022 were obtained by field epidemiological investigation.The specimens of environmental target strains were co-llected by blood nutrient agar inoculation,the removal status of environmental microorganisms and the effect of infection control after implementing control measures were com-pared.Results There were a total of 6 cases of CRKP HA-BSI,with an attacking rate of 1.29％(6/464),which was significantly higher than 0 during the same period in 2021,and difference was statistically significant(P=0.011).In environmental hygiene monitoring,the detection rate of CRKP was 2.27％(1/44),which was from the surface of bed curtain in the living unit of infected patients,homology analysis with CRKP detected from 2 patients revealed that the 16s RNA of 3 CRKP strains was completely identical,with a similarity of 100％.Seven house-keeping genes of 3 CRKP strains were all identical and belonged to the ST11 type.Comprehensive control measures were taken:appropriate closure of the ward,centralized isolation of patients,terminal disinfection of the ward,reg-ular health care workers and relative restriction of their activity areas.After the measures were taken,the qualified rate of microbial colony count in the ward increased compared to before taking the measures(2.27％vs 68.89％,P＜0.001),with a statistically significant difference,there were no more CRKP infected cases after the intervention,indicating that the control measures were effective.Conclusion This outbreak was caused by ST11 type of common CRKP in China,and laminar bed curtains are carriers of pathogen transmission.It is speculated that non-standard cleaning and disinfection,as well as inadequate implementation of hand hygiene are the main causes for transmis-sion.Adopting an appropriate strategy of closing the ward and concentrating patient isolation can quickly and effec-tively prevent the transmission of the event.
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Objective To analyze the epidemiological characteristics of an outbreak of carbapenem resistant Klebsiella pneumoniae(CRKP)hospital infection in the neonatal intensive care unit(NICU),and to explore possible causes of the outbreak.Methods Case analysis,epidemiological studies and environmental detection methods were used to investigate the detection of CRKP in the NICU of a hospital from March 11,2022 to May 3,2022,and the causes and corresponding prevention and control measures were analyzed.Results This CRKP outbreak in the NICU occurred in two phases.The first phase was from March 11,2022,to March 30,2022,during which 3 people contracted CRKP hospital infections.The second phase was from April 13,2022,to May 3,2022,during which 4 people contracted CRKP hospital infections.The source of the hospital infection outbreak was patient No.1.All 13 CRKP cases showed sensitivity only to amikacin and tigecycline,with intermediate sensitivity to levofloxacin,and high resistance to other antibiotics.All 13 CRKP cases carried resistant genes for metalloenzymes.After the outbreak,the ward environment was sampled three times,with 35 samples taken in total,and 14 of them tested positive for CRKP.After strict environmental cleaning,disinfection,and multiple control measures,no new hospital infection cases similar to this outbreak were detected after May 13,2022.Conclusion The outbreak of NICU hospital infections may be due to the contamination of the ward environment,medical equipment,and inadequate hand hygiene of medical staff,leading to its spread.Therefore,strict cleaning and disinfection of the environmental surfaces,strengthening hand hygiene of medical staff,and implementing multiple measures can effectively control hospital infections of CRKP.
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PURPOSE@#COVID-19 is also referred to as a typical viral septic pulmonary infection by 2019-nCoV. However, little is known regarding its characteristics in terms of systemic inflammation and organ injury, especially compared with classical bacterial sepsis. This article aims to investigate the clinical characteristics and prognosis between COVID-19-associated sepsis and classic bacterial-induced sepsis.@*METHODS@#In this retrospective cohort study, septic patients with COVID-19 in the intensive care unit (ICU) of a government-designed therapy center in Shenzhen, China between January 14, 2020 and March 10, 2020, and septic patients induced by carbapenem-resistant klebsiella pneumonia (CrKP) admitted to the ICU of the Second People's Hospital of Shenzhen, China between January 1, 2014 and October 30, 2019 were enrolled. Demographic and clinical parameters including comorbidities, critical illness scores, treatment, and laboratory data, as well as prognosis were compared between the two groups. Risk factors for mortality and survival rate were analyzed using multivariable logistic regression and survival curve, respectively.@*RESULTS@#A total of 107 patients with COVID-19 and 63 patients with CrKP were enrolled. A direct comparison between the two groups demonstrated more serious degrees of primary lung injury following 2019-nCoV infection (indicated by lower PaO@*CONCLUSION@#Critical COVID-19 shares clinical characteristics with classical bacterial sepsis, but the degree of systemic inflammatory response, secondary organ damage and mortality rate are less severe. However, following 2019-nCoV infection, the level of immunosuppression may be increased and thus induce in more death at the later stage of patients' hospitalstay.
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Humans , COVID-19 , Carbapenems , Hospital Mortality , Intensive Care Units , Klebsiella , Prognosis , Retrospective Studies , SARS-CoV-2 , SepsisABSTRACT
Objective:To investigate the in vitro antibacterial effects of imipenem combined with common antibiotics on bla KPC-2 type carbapenem resistant klebsiella pneumoniae (CRKP) targeting bla KPC-2 gene. Methods:Six strains of unrepeated bla KPC-2 type confirmed by polymerase chain reaction and DNA sequence were isolated in Yueqing People's Hospital, China between January 2018 and January 2019 were included in this study. The susceptibility rate of imipenem against nine conventionally used antibiotics was determined. The sensitivity test of imipenem combined with eight antibiotics was performed with the checkerboard method. Fractional inhibitory concentration was calculated to assess the efficacy of imipenem combined with common antibiotics. The in vitro treatment time-antibacterial effect curve was drawn to evaluate the antibacterial effects. Results:The resistance rate of six strains of bla KPC-2 type was 100.00% (6/6) for imipenem, meropenem, ceftazidime, ciprofloxacin, rifampicin and cefotaxime, and it was 66.67% (4/6) for minocycline and clavulanic acid and 33.33% (2/6) for tigecycline. Imipenem combined with tigecycline had a better antibacterial effect and exhibited a synergistic effect on four strains of bla KPC-2 type CRKP and an additive effect on two strains of Bla KPC-2 type CRKP. The curve of time for in vitro treatment of KPN2 with imipenem combined with tigecycline against bactericidal effect revealed that the antibacterial rate of imipenem at the 1/2 minimum inhibitory concentration combined with tigecycline at the 1/4 minimum inhibitory concentration was > 95% at (t+2) and the antibacterial effect could maintain (t+10) hours to (t+12) hours. The antibacterial rate of imipenem combined with tigecycline against strain 002 was gradually decreased with time, and the growth curve of strain 002 rised gradually. Conclusion:In vitro drug sensitivity test revealed that imipenem combined with tigecycline exhibits a good synergistic effect on bla KPC-2 type CRKP. Findings from this study provide a reference for clinical treatment of bla KPC-2 type CRKP.
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Objective To evaluate the accuracy of VITEK 2 Compact in the detection of the drug susceptibility of carbapenemresistant Klebsiella pneumoniae (CRKP) to Amikacin.Methods The susceptibility for 147 isolates of SRKP to Amikacin were detected by VITEK 2 Compact,disk diffusion method (K-B method) and E-test method,respectively.Results Among the 147 strains of Klebsiella pneumoniae,the drug susceptibility results were consistent between K B and E-test method.Among the 5 strains,the results were totally consistent by VITEK 2 Compact,K-B method and E test method,of which 4 strains were sensitive,1 strains were resistant.There were 142 strains being not consistent between VITEK 2 Compact and E-test method.The results of VITEK 2 Compact were sensitive or intermediate,while E test were drug resistance.Conclusion VITEK 2 Compact is not reliable for the detection of CRKP to Amikacin,which requires that K B method or other methods should be used for the susceptibility of CRKP to Amikacin.
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Objective To analyze the medical environmental distribution characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP).Methods On April 25 and August 29,2016,random sampling was performed be-fore cleaning and disinfecting the surrounding of patients who isolated CRKP in a hospital,sampling were mainly object surfaces and medical devices.Distribution characteristics of CRKP were analyzed.Results The number of environmental sampling in surgical intensive care unit(SICU),respiratory ICU(RICU),and emergency ICU(EICU) were 90,41,and 56 respectively.CRKP was not found in SICU and RICU specimens;6 strains of CRKP were iso-lated in EICU,the isolation rate was 10.71%.In April 2016,103 specimens were taken,and 6 strains of CRKP were isolated,isolation rate was 5.83%,which was higher than in August of 2016(P <0.05).There were no sig-nificant differences in isolation rates of CRKP among different specimens and different responsible persons (all P >0.05).Conclusion Key departments,such as EICU,should be intensified cleaning and disinfection,so as to re-duce the spread of CRKP in the medical environment.
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Objective To analyze the medical environmental distribution characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP).Methods On April 25 and August 29,2016,random sampling was performed be-fore cleaning and disinfecting the surrounding of patients who isolated CRKP in a hospital,sampling were mainly object surfaces and medical devices.Distribution characteristics of CRKP were analyzed.Results The number of environmental sampling in surgical intensive care unit(SICU),respiratory ICU(RICU),and emergency ICU(EICU) were 90,41,and 56 respectively.CRKP was not found in SICU and RICU specimens;6 strains of CRKP were iso-lated in EICU,the isolation rate was 10.71%.In April 2016,103 specimens were taken,and 6 strains of CRKP were isolated,isolation rate was 5.83%,which was higher than in August of 2016(P <0.05).There were no sig-nificant differences in isolation rates of CRKP among different specimens and different responsible persons (all P >0.05).Conclusion Key departments,such as EICU,should be intensified cleaning and disinfection,so as to re-duce the spread of CRKP in the medical environment.