Risk factors and prognosis analysis of carbapenem-resistant Klebsiella pneumoniae infection for inpatients in hepatobiliary surgery / 中华肝胆外科杂志

ABSTRACT

Objective:To explore the risk factors and prognosis of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection for inpatients in hepatobiliary surgery. Methods:The clinical data of patients with Klebsiella pneumoniae infection admitted to the Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital from January 2016 to December 2020 were retrospectively analyzed. For each patient with CRKP infection, two patients with non-carbapenem-resistant Klebsiella pneumoniae (non-CRKP) infection were selected for matching. A total of 720 patients with Klebsiella pneumoniae infection were involved, including 444 males and 276 females, aged (58.0±11.6) years old. According to the infection conditions, they were divided into two groups CRKP group ( n=240) and non-CRKP group ( n=480). The 240 CRKP patients were divided into two subgroups according to their prognosis death group ( n=34) and survival group ( n=206). The general information, laboratory test results, antibiotic use and infection outcomes of patients were recorded to analyze the risk factors of infection and death after infection. Results:Acute pancreatitis ( OR=3.473, 95% CI 1.844-6.541), chronic cardiovascular disease before infection ( OR=2.028, 95% CI 1.228-3.347), chronic renal failure ( OR=1.873, 95% CI 1.142-3.073), hypoalbuminemia ( OR=3.060, 95% CI 1.869-5.010), use of carbapenems ( OR=3.882, 95% CI 2.518-5.985), admission to intensive care unit ( OR=1.783, 95% CI 1.034-3.075) and surgery within 30 days before infection ( OR=13.463, 95% CI 7.482-24.223) were independent risk factors for CRKP infection inpatients in hepatobiliary surgery(all P<0.05). Chronic respiratory disease before infection ( OR=3.784, 95% CI 1.420-10.089), mechanical ventilation ( OR=5.085, 95% CI 1.436-18.011), disturbance of consciousness ( OR=40.710, 95% CI 3.564-464.943), hormone therapy ( OR=14.977, 95% CI 3.819-58.743) and treatment of quinolone antibiotics ( OR=4.102, 95% CI 1.226-13.726) were independent risk factors for death of inpatients with CRKP infection in hepatobiliary surgery (all P<0.05). The resistance of amikacin, tobramycin, ceftazidime, cefepime, aztreonam, ciprofloxacin, levofloxacin, co-sulfamethoxazole and piperacillin/tazobactamand in CRKP group were significantly different compared with non-CRKP group (all P<0.05). Conclusion:The occurrence of CRKP infection for inpatients in hepatobiliary surgery is related to various factors such as underlying diseases, antibiotic use and self-barrier destruction, and these factors affect the infection outcome of patients.