Infection and Drug Resistance (Jun 2020)
Increased Antimicrobial Resistance among Sputum Pathogens from Patients with Hyperglycemia
Abstract
Huahua Yi,1,2,* Jingwen Huang,1,2,* Lingxi Guo,1,2 Qiurui Zhang,1,2 Jieming Qu,1,2 Min Zhou1,2 1Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Min Zhou; Jieming QuDepartment of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai 200025, People’s Republic of ChinaEmail [email protected]; [email protected]: Glucose management is of great significance. Infection and hyperglycemia are a vicious circle. This study was conducted to describe distribution and antimicrobial resistance of bacteria isolated from patients with normoglycemia, hyperglycemia, or diabetes on admission.Methods: A retrospective study was conducted in a teaching hospital from January 2015 to March 2017. Bacteria were identified by the Vitek 2 automated system and antimicrobial susceptibility determined.Results: A total of 1,163 patients were included: 582 with normoglycemia, 292 with hyperglycemia and 289 with diabetes. Enterobacter, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterococcus faecium were the main species isolated from these patients, with 1,616 unduplicated isolates from sputum samples. Patients with hyperglycemia were more prone to carry more than one species, and the rate of multidrug-resistant K. pneumoniae and methicillin-resistant S. aureus was higher in this group. K. pneumoniae from hyperglycemia patients demonstrated increased resistance to carbapenems, especially imipenem (p=0.002) and meropenem (p=0.003), than those isolated from patients with normoglycemia or diabetes. No significance was detected for K. pneumoniae, A. baumannii, or P. aeruginosa between nondiabetes and diabetes patients. In addition, hyperglycemia patients had a higher rate of ICU admission (p= 0.035) and a lower survival rate (p< 0.001).Conclusion: Patients with hyperglycemia were more prone to carry bacteria, especially multidrug-resistant K. pneumoniae and methicillin-resistant S. aureus. Assessing glucose on admission is of great significance in predicting bacterial carriage and antimicrobial resistance.Keywords: antimicrobial resistance, K. pneumoniae, S. aureus, hyperglycemia, diabetes
