Clinical distribution and drug resistance analysis of Klebsiella pneumoniae infection from tuberculosis patients of a hospital in Changsha from 2018 to 2022
Objective To investigate the change in drug resistance of Klebsiella pneumoniae detected in the tuberculosis patients of Changsha Central Hospital so as to provide a scientific basis for the rational use of antibiotics in clinical practice.Methods WHONET5.6 software was used to statistically analyze the sample source and drug resistance rate of Klebsiella pneumoniae detected in the tuberculosis patients of Changsha Central Hospital from 2018 to 2022,and SPSS21.0 software was used to compare and analyze the difference in drug resistance of Klebsiella pneumoniae between tuberculosis patients in general wards and tuberculosis patients in the intensive care unit.Results The detection rates of Klebsiella pneumoniae in samples submitted by tuberculosis patients in Changsha Central Hospital from 2018 to 2022 were 19.6％(275/1402),22.6％(316/1400),25.5％(395/1545),26.7％(377/1410),and 27.7％(368/1329),respectively.The difference between the detection rates in five years was statistically significant(x2=33.026,P=0),with an increasing trend year by year(x2Trend=30.973,P=0).From 2018 to 2022,Klebsiella pneumoniae detected in tuberculosis wards mainly came from sputum(76.6％),followed by bronchoalveolar lavage fluid(10.7％)and urine(10.1％).From 2018 to 2022,the drug resistance rate of Klebsiella pneumoniae in the tuberculosis patients to polymyxin B,tegacycline,amikacin,tobramycin,enzyme inhibitor complex,and carbapenems was low,and the drug resistance rate to cephalosporins,quinolones,aminoglycosides,tetracyclines,monocyclines,sulfonamides and other antibiotics was high.In the past five years,the drug resistance rate of Klebsiella pneumoniae to levofloxacin,cefepime,minocycline,tegacyclin and polymyxin B has changed significantly(P＜0.05).Among the antibiotics tested,except polymyxin B and cefoperazone/sulbactam,the drug resistance rate of each antibiotic increased significantly in 2019,but declined and remained stable after 2020.The average resistance rate of Klebsiella pneumoniae detected in patients from the tuberculosis general ward to tested antibiotics(except polymyxin B)during the past 5 years was lower than that in patients in the tuberculosis intensive care unit,and the difference was statistically significant(P＜0.05).From 2018 to 2022,the detection rate of CR-KP in tuberculosis patients was 11.3％(31/275),14.9％(47/316),12.2％(48/395),15.9％(60/377),and 11.4％(42/368),respectively.The detection rate of CR-KP didn't show statistically significant differences(P＜0.05)during the five years.CR-KP only maintained a high sensitivity to polymyxin B,with a resistance rate of less than 5％,while it showed varying degrees of resistance to other antibiotics.Conclusion The detection rate of Klebsiella pneumoniae in the samples submitted by tuberculosis patients in Changsha Central Hospital has been rising year by year,showing different degrees of resistance to various antibiotics.In clinical practice,it's suggested that the drug resistance monitoring of Klebsiella pneumoniae infection in tuberculosis patients and antibiotics reasonable and normative usage need to be strengthened.
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