Surveillance and epidcrmiological characteristics of patients with intestinal colonization and infection of carbapenem-resistance Klebsiella pneumoniae
OBJECTIVE To study the epidemiological characteristics of intestinal colonization of carbapenem-resist-ant Klebsiella pneumoniae(CRKP)and the risk factors of healthcare associated infections(HAIs),and to ex-plore the prevention and control strategies that are suitable for clinical practice and can effectively reduce the prev-alence of CRKP and infections.METHODS Inpatients with CRKP intestinal colonization in the First Affiliated Hospital of Wenzhou Medical University between 2018 and 2020 were screened,the clinical characteristics and in-fection risk factors of the population with hospital-acquired infections only and after colonization were analyzed and compared.The molecular epidemiological characteristics of CRKP strains were analyzed by whole-genome sequen-cing,including carbapenemase type,virulence gene,capsular serotype and multi-locus sequence typing(MLST).CRKP intestinal surveillance and infection prevention and control improvement strategies in line with the actual situation of hospitals were formulated and implemented,and the data on CRKP intestinal colonization rate,detec-tion rate and hospital infection rate were continually monitored in order to ensure the effectiveness of the whole process of CRKP hospital management and prevention and control.RESULTS Hospital-acquired infections occurred in 16(34.78％ )of 46 CRKP colonized patients.Coma,(OR=9.000,95％ CI:1.922-42.139,P=0.005)and glu-cocorticoids(OR=0.115,95％ CI:0.013-0.995,P=0.005)were influencing factors for HAIs.CRKP strains had a high level of resistance to drugs,and were 100％ sensitive to tigecycline and polymyxin.The strains mainly car-ried the bla KPC-2 carbapenemase gene,the capsular serotypes were dominated by K14 and K64,the virulence gene rmpA was carried at a higher rate in infected group(P＜0.05),and the multilocus sequence typing was mainly dominated by ST11 and ST15.The IPC improvement measures of CRKP achieved remarkable results,including u-nified management organization,precise screening and informatization management etc.The effectiveness of CRKP infection prevention and control in hospitals was remarkable,with the positive rate of CRKP intestinal screen-ing,the detection rate and HAIs incidence rate of CRKP all decreasing continuously(P＜0.05).CONCLUSIONS Patients with CRKP intestinal colonization were at high risk of developing extraintestinal hospital-acquired infections due to the role of infection risk factors in various diagnoses and treatments,and there were differences in virulence between colonized and hospital-acquired strains.Improved prevention and control strategies such as accurate intestinal screening and informa-tion-based total process management can effectively reduce the transmission prevalence and cross-infection of CRKP.
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