Correlation between carbapenem consumption and the detection of carbapenem-resistant Klebsiella pneumoniae infections at a tertiary hospital in China from 2014 to 2018
Objective To investigated the relationship between the antibiotic use density(AUD)of carbapenems and the detection trend of carbapenem-resistant Klebsiella pneumoniae(CRKP),and provide a basis for clinical control of bacterial resistance and the rational use of antibiotics.Methods This study retrospectively collected data on defined daily doses(DDDs)of carbapenems and detection of CRKP in Hangzhou First People's Hospital Affiliated to Westlake University from the first quarter of 2014 to the fourth quarter of 2018.The correlation between the AUD and the detection rate of CRKP was carried out using SPSS version 23.0.Results During the 5-year study period,924 isolates of CRKP were observed,of which 78 were isolated from bloodstream infections(8.4%).The detection rate of CRKP and the incidence of CRKP bloodstream infection were both positively correlated with the AUD of carbapenems(r=0.575,P=0.008;r=0.584,P=0.007).Prior to implementing the antimicrobial restriction system in April 2016,the incidence of CRKP BSIs increased from 0.08/1,000 patient-days in the first quarter of 2014 to 0.60/1,000 patient-days in the first quarter of 2016,while the quarterly AUD of carbapenems also increased from 2.84 to 4.47(r=0.669,P=0.049).The same increasing trend between the detection rate of CRKP and the AUD of carbapenems from the fourth quarter of the previous year to the first quarter of the following year was also observed.Conclusion This study showed that the factors affecting the prevalence of CRKP infections were complicated,and the AUD of carbapenems was one of the important factors.In particular,the AUD of carbapenems before the control was not implemented was associated with an increase in the detection of CRKP and the incidence of CRKP bloodstream infection.With the increasing detection rate of CRKP,it is necessary to control the rational use of carbapenems.