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Abstract：
BACKGROUND: The aim of our study was to analyze the factors associated with the increased risk of urinary tract infection (UTI) with carbapenem-resistant (CR) Klebsiella pneumoniae (Kpn) and the antibiotic resistance spectrum of the strains in patients. As secondary objectives, we elaborated the profile of these patients and the incidence of different types of carbapenemases.
METHODS: We conducted a retrospective case-control study in which we compared a group of 62 patients with urinary tract infections with CR Kpn with a control group consisting of 136 patients with urinary tract infections with multidrug-resistant (MDR), but carbapenem-sensitive (CS), Kpn, who were hospitalized between 1 January 2022 and 31 March 2024.
RESULTS: Compared to patients with urinary tract infections with CS Kpn, patients with urinary tract infections with CR Kpn were preponderant in rural areas (62.9% vs. 47.1%, p = 0.038) and more frequently had an upper urinary tract infection (69.4% vs. 36.8%, p < 0.01). Among the risk factors examined, patients in the study group had a higher presence of urinary catheters inserted for up to one month (50% vs. 34.6%, p = 0.03), rate of hospitalization in the last 180 days (96.8% vs. 69.9%, p < 0.01) and incidence of antibiotic therapy in the last 180 days (100% vs. 64.7%, p < 0.01). They also had a higher rate of carbapenem treatment in the last 180 days (8.1% vs. 0%, p < 0.01). Patients in the study group had a broader spectrum of resistance to all antibiotics tested (p < 0.01), with the exception of sulfamethoxazole-trimethoprim, where the resistance rate was similar in both groups (80.6% vs. 67.6%, p = 0.059). In the multivariate analysis, transfer from other hospitals (OR = 3.51, 95% and CI: 1.430-8.629) and treatment with carbapenems in the last 180 days (OR = 11.779 and 95% CI: 1.274-108.952) were factors associated with an increased risk of disease compared to the control group. The presence of carbapenemases was observed in all patients with CR Kpn, in the order of frequency New Delhi metallo-ß-lactamase (NDM) (52.2%), Klebsiella pneumoniae carbapenemase (KPC) (32.6%), and carbapenem-hydrolyzing oxacillinase (Oxa-48) (15.2%).
CONCLUSIONS: The environment of origin and previous treatment with carbapenems appear to be the factors associated with an increased risk of urinary tract infection with CR Kpn compared to patients with urinary tract infections with CS Kpn. CR Kpn exhibits a broad spectrum of antibiotic resistance, among which is resistance to carbapenem antibiotics.
METHODS: We conducted a retrospective case-control study in which we compared a group of 62 patients with urinary tract infections with CR Kpn with a control group consisting of 136 patients with urinary tract infections with multidrug-resistant (MDR), but carbapenem-sensitive (CS), Kpn, who were hospitalized between 1 January 2022 and 31 March 2024.
RESULTS: Compared to patients with urinary tract infections with CS Kpn, patients with urinary tract infections with CR Kpn were preponderant in rural areas (62.9% vs. 47.1%, p = 0.038) and more frequently had an upper urinary tract infection (69.4% vs. 36.8%, p < 0.01). Among the risk factors examined, patients in the study group had a higher presence of urinary catheters inserted for up to one month (50% vs. 34.6%, p = 0.03), rate of hospitalization in the last 180 days (96.8% vs. 69.9%, p < 0.01) and incidence of antibiotic therapy in the last 180 days (100% vs. 64.7%, p < 0.01). They also had a higher rate of carbapenem treatment in the last 180 days (8.1% vs. 0%, p < 0.01). Patients in the study group had a broader spectrum of resistance to all antibiotics tested (p < 0.01), with the exception of sulfamethoxazole-trimethoprim, where the resistance rate was similar in both groups (80.6% vs. 67.6%, p = 0.059). In the multivariate analysis, transfer from other hospitals (OR = 3.51, 95% and CI: 1.430-8.629) and treatment with carbapenems in the last 180 days (OR = 11.779 and 95% CI: 1.274-108.952) were factors associated with an increased risk of disease compared to the control group. The presence of carbapenemases was observed in all patients with CR Kpn, in the order of frequency New Delhi metallo-ß-lactamase (NDM) (52.2%), Klebsiella pneumoniae carbapenemase (KPC) (32.6%), and carbapenem-hydrolyzing oxacillinase (Oxa-48) (15.2%).
CONCLUSIONS: The environment of origin and previous treatment with carbapenems appear to be the factors associated with an increased risk of urinary tract infection with CR Kpn compared to patients with urinary tract infections with CS Kpn. CR Kpn exhibits a broad spectrum of antibiotic resistance, among which is resistance to carbapenem antibiotics.
摘要：
背景：我们的研究目的是分析耐碳青霉烯（CR）肺炎克雷伯菌（Kpn）尿路感染（UTI）风险增加的相关因素以及患者中这些菌株的抗生素耐药谱。作为次要目标，我们阐述了这些患者的概况和不同类型的碳青霉烯酶的发生率。
方法：我们进行了一项回顾性病例对照研究，其中我们比较了62例尿路感染的CRKpn患者与136例多药耐药（MDR）尿路感染患者的对照组。但碳青霉烯敏感（CS），Kpn,他们在2022年1月1日至2024年3月31日期间住院。
结果：与CSKpn尿路感染患者相比，农村地区尿路感染CRKpn的患者占优势(62.9%vs.47.1%,p=0.038），并且更频繁地患有上尿路感染（69.4％vs.36.8%,p<0.01)。在检查的风险因素中，研究组中的患者在长达一个月的时间内插入了更高的导尿管(50%vs.34.6%,p=0.03),过去180天的住院率（96.8%vs.69.9%,p<0.01）和过去180天内抗生素治疗的发生率（100％vs.64.7%,p<0.01)。在过去的180天内，他们的碳青霉烯治疗率也较高(8.1%vs.0%,p<0.01)。研究组患者对所有测试的抗生素具有更广泛的耐药性（p<0.01），除了磺胺甲恶唑-甲氧苄啶，两组的耐药率相似(80.6%vs.67.6%,p=0.059)。在多变量分析中，与对照组相比,从其他医院转院(OR=3.51,95%,CI:1.430~8.629)和最后180天使用碳青霉烯类抗生素治疗(OR=11.779,95%CI:1.274~108.952)是与疾病风险增加相关的因素.在所有CRKpn患者中观察到碳青霉烯酶的存在，在频率顺序新德里金属β-内酰胺酶（NDM）（52.2%），肺炎克雷伯菌碳青霉烯酶(KPC)(32.6%),和碳青霉烯类水解氧嘧啶酶(Oxa-48)(15.2%)。
结论：与CSKpn尿路感染患者相比，来源环境和先前使用碳青霉烯类抗生素的治疗似乎是增加CRKpn尿路感染风险的相关因素。CRKpn表现出广谱的抗生素耐药性，其中包括对碳青霉烯类抗生素的耐药性。
方法：我们进行了一项回顾性病例对照研究，其中我们比较了62例尿路感染的CRKpn患者与136例多药耐药（MDR）尿路感染患者的对照组。但碳青霉烯敏感（CS），Kpn,他们在2022年1月1日至2024年3月31日期间住院。
结果：与CSKpn尿路感染患者相比，农村地区尿路感染CRKpn的患者占优势(62.9%vs.47.1%,p=0.038），并且更频繁地患有上尿路感染（69.4％vs.36.8%,p<0.01)。在检查的风险因素中，研究组中的患者在长达一个月的时间内插入了更高的导尿管(50%vs.34.6%,p=0.03),过去180天的住院率（96.8%vs.69.9%,p<0.01）和过去180天内抗生素治疗的发生率（100％vs.64.7%,p<0.01)。在过去的180天内，他们的碳青霉烯治疗率也较高(8.1%vs.0%,p<0.01)。研究组患者对所有测试的抗生素具有更广泛的耐药性（p<0.01），除了磺胺甲恶唑-甲氧苄啶，两组的耐药率相似(80.6%vs.67.6%,p=0.059)。在多变量分析中，与对照组相比,从其他医院转院(OR=3.51,95%,CI:1.430~8.629)和最后180天使用碳青霉烯类抗生素治疗(OR=11.779,95%CI:1.274~108.952)是与疾病风险增加相关的因素.在所有CRKpn患者中观察到碳青霉烯酶的存在，在频率顺序新德里金属β-内酰胺酶（NDM）（52.2%），肺炎克雷伯菌碳青霉烯酶(KPC)(32.6%),和碳青霉烯类水解氧嘧啶酶(Oxa-48)(15.2%)。
结论：与CSKpn尿路感染患者相比，来源环境和先前使用碳青霉烯类抗生素的治疗似乎是增加CRKpn尿路感染风险的相关因素。CRKpn表现出广谱的抗生素耐药性，其中包括对碳青霉烯类抗生素的耐药性。
