Current status and drug resistance analysis of Klebsiella pneumoniae in orthopedic wound infections and the risk factors for the increase of drug resistance rate in Yichang city
Objective To analyze the current status of Klebsiella pneumoniae in orthopedic wound infections and the risk fac-tors for the increase of drug resistance rate in Yichang city,aiming to guide clinical treatment.Methods A retrospective analy-sis of patients with Klebsiella pneumoniae infection in orthopedic wound admitted to Orthopaedics Department of Yichang City Central People's Hospital from January 2017 to June 2022 was conducted.Bacterial culture and strain identification were per-formed according to the routine methods of clinical microbiological examination.The disk diffusion method(K-B method)was used to determine the diameter of inhibitory ring of strains against antibacterial drugs,and the results were judged according to the standards of American Clinical Laboratory Standardization Committee(2016 edition).The drug resistance rates of commonly used antibacterial drugs ceftazidime,cefepime,piperacillin tazobactam,levofloxacin,sulfanilamide,imipenem,and amikacin were counted.The patients were divided into four groups and subgroups according to whether they had undergone multiple sur-geries,whether they had applied antibacterial drugs before sampling,whether they had mixed bacterial infections,and whether they had diabetes,and then the risk factors of increased drug resistance rates that were highly related to surgery were further analyzed.Results After removing duplicate strains,a total of 81 strains of Klebsiella pneumoniae were detected among 1 319 positive strains of orthopedic wound infection accounting for 6.14％.Compared with the single operation group(n=33),the drug resistance rates of ceftazidime(x2=6.278,P=0.012),cefepime(x2=10.197,P=0.001),piperacillin tazobactam(x2=10.206,P=0.001),levofloxacin(x2=9.857,P=0.002),sulfanilamide(x2=3.909,P=0.048)and imipenem(x2=4.753,P=0.029)of Klebsi-ella pneumoniae isolated from the multiple operation group(n=48)were significantly increased.However,there was no signifi-cant difference in amikacin resistance rates between the two groups(P＞0.05).The drug resistance rate of ceftazidime(x2=8.416,P=0.004),cefepime(x2=10.940,P=0.001),levofloxacin(x2=9.051,P=0.003),and sulfonamide(x2=6.671,P=0.010)in Klebsi-ella pneumoniae isolated from the antibacterial group(n=63)was significantly higher than that of the non-antibacterial group(n=18),but there was no significant difference in the drug resistance rates of piperacillin tazobactam,imipenem and amikacin between the two groups(P＞0.05).The drug resistance rates of ceftazidime(x2=3.889,P=0.049)and cefepime(x2=4.531,P=0.033)isolated from the mixed infection group(n=36)were significantly higher than those of the simple infection group(n=45),but there was no significant difference in the drug resistance rates of piperacillin tazobactam,levofloxacin,sulfanil-amide,imipenem and amikacin between the two groups(P＞0.05).In the drug susceptibility tests of seven common antibacterial drugs,there was no significant difference in the overall drug resistance rate of Klebsiella pneumoniae isolated from the diabetes group(n=15)and the non-diabetes group(n=66)(P＞0.05).Conclusion Klebsiella pneumoniae is common in orthopedic wound infections,and its drug resistance is common.The drug resistance rate of the pathogenic bacterium Klebsiella pneumoniae de-tected in orthopedic wounds in Yichang city has a trend of increasing year by year.In addition,multiple surgeries on the same trauma,application of antibacterial drugs and mixed infections are risk factors for increased drug resistance,while diabetes does not increase drug resistance.
万方数据
维普
