Epidemiologic analysis and control strategy of Klebsiella pneumoniae infection in intensive care units in a teaching hospital of People’s Republic of China

Figures & data

Table 1 Demographic and clinical characteristics of patients with KP infection in ICU in 2013–2017, n (%)

Clinical characteristics	Non-ESBLs/CRKP (n=479)	ESBLKP (n=299)	CRKP (n=69)	KP (N=847)
Length of stay (days)	18.3±16.5	28.7±24.1	34.2±26.5	26.2±22.6
Age (years) ≥60	319 (66.60%)	197 (65.88%)	54 (78.26%)	570 (64.80%)
Male gender	286 (59.71%)	203 (67.89%)	50 (72.46%)	539 (63.63%)
Chronic diseases
Diabetes	214 (44.68%)	137 (45.82%)	30 (43.47%)	381 (44.98%)
Hypertension	96 (20.04%)	210 (70.23%)	24 (34.78%)	330 (38.96%)
CHD	63 (13.15%)	53 (17.73%)	19 (27.54%)	135 (15.94%)
Cerebrovascular accident	15 (3.13%)	126 (42.14%)	15 (21.74%)	156 (18.42%)
Renal failure	15 (3.13%)	53 (17.73%)	13 (18.84%)	81 (9.56%)
Heart failure	48 (10.02%)	62 (20.74%)	17 (24.64%)	127 (14.99%)
Malignant tumor	82 (17.12%)	48 (16.05%)	8 (11.59%)	138 (16.29%)
Clinical symptoms
Fever	479 (100.00%)	299 (100.00%)	69 (100.00%)	847 (100.00%)
WBC >4.0×10^9/L	440 (91.86%)	245 (81.94%)	60 (86.95%)	745 (87.95%)
NEU >75%	409 (85.39%)	244 (81.60%)	58 (84.06%)	711 (83.94%)
PCT >4.0×10^9/L	464 (96.87%)	283 (94.65%)	64 (92.75%)	811 (95.75%)
CRP >10 mg/L	479 (100.00%)	299 (100.00%)	69 (100.00%)	847 (100.00%)
Outcome
Septic shock	177 (36.95%)	182 (60.87%)	52 (75.36%)	411 (48.52%)
MOD	132 (27.56%)	143 (47.83%)	46 (66.67%)	321 (37.89%)
Source of infection
Pneumonia	317 (66.18%)	215 (71.90%)	52 (75.36%)	584 (68.94%)
Acute pyelonephritis	88 (18.37%)	28 (9.36%)	12 (17.40%)	128 (15.11%)
Bloodstream infection	45 (9.39%)	17 (5.69%)	6 (8.70%)	68 (8.03%)
Central venous catheter related	12 (2.51%)	28 (9.36%)	8 (11.60%)	48 (5.67%)
Incision infection	17 (3.55%)	15 (5.02%)	5 (7.25%)	37 (4.37%)
Specimen type
Sputum	328 (68.48)	210 (70.23%)	46 (66.67%)	584 (70.84)
Urine	73 (15.24)	45 (15.05)	10 (14.49)	128 (6.26)
Bloodstream	34 (5.0)	28 (9.36)	6 (8.69)	68 (5.79)
Bronchoalveolar lavage fluids	16 (3.34)	11 (3.67)	3 (4.34)	30 (3.54)
Sterile sitea	16 (3.34)	10 (3.34)	2 (2.89)	28 (3.30)

Note:

a Sterile site included cerebrospinal fluid and bile.

Abbreviations: CHD, coronary atherosclerotic heart disease; CRKP, carbapenem-resistant KP; CRP, C-reactive protein; ESBL, extended-spectrum β-lactamase; ICU, intensive care unit; KP, Klebsiella pneumoniae; MOD, multiple organ dysfunction; NEU, neutrophil percentage; PCT, procalcitonin; WBC, white blood cell count.

Table 2 Resistance rates of 847 Klebsiella pneumoniae strains to antimicrobial agents (%)

Antimicrobial agent	2013 (n=189)	2014 (n=150)	2015 (n=171)	2016 (n=162)	2017 (n=175)	2013–2017 (N=847)
Ampicillin	100.0	100.0	100.0	100.0	100.0	100.0
Ceftazidime	25.9	26.0	29.2	30.6	28.6	28.1
Ceftriaxone	41.3	40.7	41.5	47.8	50.6	44.4
Cefepime	14.1	14.0	19.6	25.7	32.3	21.2
Cefoxitin	14.4	15.2	16.5	24.7	33.7	25.1
Cefotetan	2.7	2.7	2.4	12.4	14.9	7.0
Ampicillin–sulbactam	50.3	50.7	46.8	53.4	52.0	40.5
Piperacillin–tazobactam	4.8	6.0	6.6	16.8	18.1	10.4
Cefoperazone–sulbactam	3.1	6.6	9.2	18.8	20.7	15.4
Ertapenem	5.4	4.8	3.0	12.6	16.2	8.4
Imipenem	2.1	2.7	2.9	11.8	16.0	7.1
Meropenem	0.0	0.0	3.1	11.9	16.2	10.3
Amikacin	12.3	11.5	4.9	13.6	12.6	10.9
Gentamicin	30.2	28.0	26.9	36.7	34.9	31.3
Ciprofloxacin	25.4	26.7	23.4	24.8	21.7	24.3
Minocycline	27.0	26.6	33.1	28.5	30.0	30.5
Tigecycline	0.0	0.0	0.0	0.0	0.0	0.0

Table 3 Resistance rate of 299 ESBL-producing Klebsiella pneumoniae strains to antimicrobial agents (%)

Antimicrobial agent	2013 (n=63)	2014 (n=49)	2015 (n=64)	2016 (n=55)	2017 (n=68)	2013–2017 (n=299)
Ceftazidime	50.8	55.1	59.7	65	74	61
Ceftriaxone	96.8	95.9	100	98.2	98.5	98
Cefepime	46	48.1	56.2	60	64.7	53.1
Cefoxitin	15.7	16.8	21	18.9	19.7	19,9
Cefotetan	1.6	2	0	0	0	0.7
Ampicillin–sulbactam	95.2	93.9	96.9	90.9	94.1	94.3
Piperacillin–tazobactam	7.9	8.2	11.1	12.7	14.7	11.1
Cefoperazone–sulbactam	0	0	14.5	20.4	22.7	18.6
Ertapenem	0	0	0	0	0	0
Imipenem	0	0	0	0	0	0
Meropenem	0	0	0	0	0	0
Amikacin	23.3	21.3	11.1	5.8	11.7	14.5
Gentamicin	52.4	51	62.5	61.8	58.8	57.5
Ciprofloxacin	47.6	46.9	48.4	29	30.9	40.5
Minocycline	55.9	55	56.5	56.6	56.9	56.7
Tigecycline	0	0	0	0	0	0

Abbreviation: ESBL, extended-spectrum β-lactamase.