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Abstract：
BACKGROUND: The antimicrobial resistance (AMR) of Klebsiella pneumoniae recorded a steep upward trend over the last two decades, among which carbapenem-resistant Klebsiella pneumoniae (CRKP) is one of the most concerning strains considering the development and spread of AMR. The aim of this study was to analyze the evolution of AMR for Klebsiella pneumoniae and to describe the risk factors of AMR for Klebsiella pneumoniae, including the COVID-19 pandemic.
METHODS: We conducted a retrospective study on Klebsiella pneumoniae non-duplicative isolates collected from patients admitted to a tertiary hospital in Bucharest, Romania, from January 2019 to December 2021. We evaluated AMR changes by comparing resistance between 2019 and the mean of 2020-2021.
RESULTS: The rates of AMR increased for third-generation cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and colistin and decreased for trimethoprim/sulfamethoxazole (TMP/SMX), 45.7% in 2019 vs. 28.3% in 2021. A longer length of hospital stay (ꭓ2 = 49.68, p < 0.01); recent antibiotic consumption, RR = 1.38, 95% CI [1.21, 1.57]; and recent contact with hospital settings, RR = 1.54, 95% CI [1.32, 1.8] were risk factors for multidrug-resistant (MDR) Klebsiella pneumoniae.
CONCLUSIONS: The AMR of Klebsiella pneumoniae increased during 2020-2021 for most of the potential active antibiotics; only TMP/SMX resistance decreased, and it may represent a treatment option for CRKP or MDR Klebsiella pneumoniae infections. Decreasing the excessive use of antibiotics and the implementation of prevention and control measures in healthcare settings are mandatory for avoiding further increases in the AMR rate of Klebsiella pneumoniae.
METHODS: We conducted a retrospective study on Klebsiella pneumoniae non-duplicative isolates collected from patients admitted to a tertiary hospital in Bucharest, Romania, from January 2019 to December 2021. We evaluated AMR changes by comparing resistance between 2019 and the mean of 2020-2021.
RESULTS: The rates of AMR increased for third-generation cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and colistin and decreased for trimethoprim/sulfamethoxazole (TMP/SMX), 45.7% in 2019 vs. 28.3% in 2021. A longer length of hospital stay (ꭓ2 = 49.68, p < 0.01); recent antibiotic consumption, RR = 1.38, 95% CI [1.21, 1.57]; and recent contact with hospital settings, RR = 1.54, 95% CI [1.32, 1.8] were risk factors for multidrug-resistant (MDR) Klebsiella pneumoniae.
CONCLUSIONS: The AMR of Klebsiella pneumoniae increased during 2020-2021 for most of the potential active antibiotics; only TMP/SMX resistance decreased, and it may represent a treatment option for CRKP or MDR Klebsiella pneumoniae infections. Decreasing the excessive use of antibiotics and the implementation of prevention and control measures in healthcare settings are mandatory for avoiding further increases in the AMR rate of Klebsiella pneumoniae.
摘要：
背景：在过去的二十年中，肺炎克雷伯菌的抗菌素耐药性（AMR）呈急剧上升趋势，考虑到AMR的发展和传播，其中耐碳青霉烯类肺炎克雷伯菌（CRKP）是最值得关注的菌株之一。本研究的目的是分析肺炎克雷伯菌AMR的演变，并描述肺炎克雷伯菌AMR的危险因素。包括COVID-19大流行。
方法：我们对从布加勒斯特三级医院住院的患者中收集的肺炎克雷伯菌非重复分离株进行了回顾性研究，罗马尼亚,从2019年1月到2021年12月。我们通过比较2019年的阻力和2020-2021年的平均值来评估AMR变化。
结果：第三代头孢菌素的AMR率增加，碳青霉烯类,氨基糖苷类,氟喹诺酮类药物,和粘菌素和减少甲氧苄啶/磺胺甲恶唑（TMP/SMX），2019年的45.7%与2021年28.3%。住院时间较长（2=49.68，p<0.01）；最近服用抗生素，RR=1.38，95%CI[1.21，1.57]；以及最近与医院环境的接触，RR=1.54,95%CI[1.32,1.8]是多重耐药(MDR)肺炎克雷伯菌的危险因素。
结论：对于大多数潜在的活性抗生素，肺炎克雷伯菌的AMR在2020-2021年期间增加；只有TMP/SMX耐药性下降，它可能代表CRKP或MDR肺炎克雷伯菌感染的治疗选择。为了避免肺炎克雷伯菌的AMR率进一步提高，必须减少抗生素的过度使用以及在医疗机构中实施预防和控制措施。
方法：我们对从布加勒斯特三级医院住院的患者中收集的肺炎克雷伯菌非重复分离株进行了回顾性研究，罗马尼亚,从2019年1月到2021年12月。我们通过比较2019年的阻力和2020-2021年的平均值来评估AMR变化。
结果：第三代头孢菌素的AMR率增加，碳青霉烯类,氨基糖苷类,氟喹诺酮类药物,和粘菌素和减少甲氧苄啶/磺胺甲恶唑（TMP/SMX），2019年的45.7%与2021年28.3%。住院时间较长（
结论：对于大多数潜在的活性抗生素，肺炎克雷伯菌的AMR在2020-2021年期间增加；只有TMP/SMX耐药性下降，它可能代表CRKP或MDR肺炎克雷伯菌感染的治疗选择。为了避免肺炎克雷伯菌的AMR率进一步提高，必须减少抗生素的过度使用以及在医疗机构中实施预防和控制措施。
