Trends and Risk Factors of Carbapenem-resistant Klebsiella pneumoniae and Health-care Associated Infection

• Main Authors: HUANG, YI-WEN, 黃宜玟
• Other Authors: LIN, KUAN-YU
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/v5majx

碩士 === 中臺科技大學 === 護理系碩士班 === 107 === Carbapenems are broad spectrum β-lactam antibiotic agents commonly used for the treatment of multidrug-resistant bacterial infections. In recent years increasing trend of CRE- carbapenem-resistant Enterobacteriaceae, a family of Gram-negative bacillus shown, particularly carbapenem -resistant Klebsiella pneumoniae (CRKP), resulting in huge challenges and difficulties to treatment. During the period of 2015 to 2017, the CRE proportion at a medical center in central Taiwan rose from 8.2% to 12.3%, and CRKP was the highest. Therefore we started an investigation and analyzed the trend of CRKP healthcare -associated infections (HAIs) and analyze the risk factors for CRKP and HAIs. We conducted a retrospective case‑control study by analyzing HAIs information of a medical center in central Taiwan from January, 2015 to December, 2017. We divided KP infection cases into 2 groups: CRKP (case group) and non-CRKP (control group). Clinical data were collected to identify risk factors for CRKP infection. The risk factors was compared using Pearson's Chi‑square test or continuity correction (Fisher’ exact), the t‑test, and were analyzed under univariable and multivariable logistic regression model. We also calculate the odds ratios (ORs) and the 95% confidence intervals (CIs) for the dichotomous categorical variables. Two- tailed p < 0.05 was considered statistically significant. Multivariate logistic regression analysis showed 4 statistically significantly risk factors, including cardiovascular disease (OR= 3.33; 95% CI: 1.24- 8.97; p= 0.017); exposure to carbapenem (OR= 3.70; 95% CI: 1.69-8.10; p= 0.001); indwelling urinary catheter (OR=3.51; 95% CI: 1.30- 9.50; p= 0.013), and indwelling hemodialysis catheter (OR= 6.57; 95% CI: 2.17- 19.91; p= 0.001) were all independent risk factors for CRKP infections. In recent years, HAIs caused by CRKP was increasing year by year. In clinical practice we suggest the patients with cardiovascular disease, exposure to carbapenem, indwelling urinary catheter and indwelling hemodialysis catheters should avoid the using of unnecessary invasive treatment. Besides, implementation of environmental cleaning and disinfection, hand hygiene, close compliance with infection control bundles, and prudent administration of antibiotics are recommended for minimizing the risk of HAIs and acquisition of CRKP infection.