Infection and Drug Resistance (Sep 2024)
Monitoring of Klebsiella pneumoniae Infection and Drug Resistance in 17 Pediatric Intensive Care Units in China from 2016 to 2022
Abstract
Panpan Fan,1,* Pan Fu,2,3,* Jing Liu,1,* Chuanqing Wang,2,3 Xiaolei Zhang,1 Yixue Wang,1 Yingying Zhang,1 Ting Zhu,1 Caiyan Zhang,1 Guoping Lu,1 Gangfeng Yan,1 Members and affiliations of China Paediatric Intensive care Unit Pathogen Surveillance Network (CHIPS)Panpan Fan,1 Pan Fu,2 Jing Liu,1 Xiaolei Zhang,1 Yixue Wang,1 Yingying Zhang,1 Ting Zhu,1 Caiyan Zhang,1 Chuanqing Wang,2 Guoping Lu,1 Gangfeng Yan,1 Hong Ren,3 Juanzhen Li,3 Yucai Zhang,4 Yiping Zhou,4 Chengmei Zhang,5 Zhenjie Chen,5 Mingming Zhou,5 Zhengjiang Bai,6 Saihu Hang,6 Lili Hang,6 Hehe Chen,7 Yao Zheng,7 Qunying Chen,7 Pengwei Zhu,8 Yong Li,8 Yan Xu,8 BiZhen Zhu,9 Huixuan Shi,9 Shaoxian Hong,10 Yukun Huang,10 Meilian Huang,10 Danqun Jing,11 Wenjia Tong,11 ChengYu Zhang,11 Weiguo Yang,12 Weike Mang,12 Qing meng,12 Yibing Cheng,13 Qunqun Zhang,13 Kaijie Gao,13 Huiming Xu,14 Yuxia Li,14 Hanghai Ding,14 Xiulan Lu,15 Jiaotian Huang,15 Jianlong Liu,15 Yourong Zhu,16 Yuanyuan Chen,16 Shufang Xiao,17 Juan He,17 Li Jiang,17 Jianli Chen,18 Yi Lin,18 Jia Lei18 1Department of Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, People’s Republic of China; 2Lab of Microbiology, Department of Clinical Laboratory, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, People’s Republic of China; 3Nosocomial Infection Control Department, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, People’s Republic of China; 1Department of Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, People’s Republic of China; 2Clinical Microbiology Laboratory, Department of Nosocomial Infection Control, Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, People’s Republic of China; 3Department of Pediatric Intensive Care Unit, Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 4Department of Pediatric Intensive Care Unit, Shanghai Children’s Hospital affiliated to Shanghai Jiaotong University, Shanghai, People’s Republic of China; 5Department of Pediatric Intensive Care Unit, Children’s Hospital Affiliated to Zhejiang University Medical School, Hangzhou, People’s Republic of China; 6Department of Pediatric Intensive Care Unit, Children’s Hospital of Soochow University, Suzhou, People’s Republic of China; 7Department of Pediatric Intensive Care Unit, Ningbo Women and Children’s Hospital, Ningbo, People’s Republic of China; 8Department of Pediatric Intensive Care Unit, Wuxi Children’s Hospital, Wuxi, People’s Republic of China; 9Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China; 10Department of Pediatric Intensive Care Unit, Xiamen Children’s Hospital, Xiamen, People’s Republic of China; 11Department of Pediatric Intensive Care Unit, Anhui Children’s Hospital, Hefei, People’s Republic of China; 12Department of Pediatric Intensive Care Unit, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China; 13Department of Pediatric Intensive Care Unit, Henan Children’s Hospital, Zhengzhou, People’s Republic of China; 14Department of Pediatric Intensive Care Unit, Kaifeng Children’s Hospital, Kaifeng, People’s Republic of China; 15Department of Pediatric Intensive Care Unit, Hunan Children’s Hospital, Changsha, People’s Republic of China; 16Department of Pediatric Intensive Care Unit, Jiangxi Provincial Children’s Hospital, Nanchang, Kunming, People’s Republic of China; 17Department of Pediatric Intensive Care Unit, Kunming Children’s Hospital, People’s Republic of China; 18Department of Pediatric Intensive Care Unit, Guiyang Children’s Hospital, Guiyang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guoping Lu; Gangfeng Yan, Email [email protected]; [email protected]: To investigate the characteristics and drug resistance patterns of Klebsiella pneumoniae (K. pneumoniae) infection in pediatric intensive care unit (PICU).Methods: K. pneumoniae strains from 17 domestic PICUs were analyzed for overall condition and drug resistance using WHO-NET software.Results: From 2016 to 2022, there was a linear increase in the detection rate of K. pneumoniae (P< 0.05), with a total of 2591 (9.7%) strains detected. The primary sites of K. pneumoniae detection were the respiratory tract (71.1%), blood (8.6%), and urinary tract (7.1%). K. pneumoniae’s resistance to penicillin drugs exceeded 90%, and are over 50% to cephalosporins. Resistance to cefoperazone-sulbactam decreased from 51.7% to 25.7%, and ranged from 9.1% to 20.8% for ceftolozane-tazobactam. Carbapenem-resistant K. pneumoniae strains constituted 32.3%. Resistance to imipenem and meropenem have decreased to 33.8% and 40.2%, while increased to 35.2% for ertapenem. Levofloxacin and amikacin resistance rates have decreased to 25.7% and 9.1%, but remain high at 63.8% for moxifloxacin and 44.6% for ciprofloxacin. K. pneumoniae demonstrated the lowest resistance rates to polymyxin B (0.9%), tigecycline (2.2%), and polymyxin E (3.1%). No strain of K. pneumoniae was resistant to both polymyxin B and meropenem. However, some strains showed co-resistance to meropenem with other antibiotics, including tigecycline (2%), imipenem (16%), amikacin (27%), colistin (37%), and levofloxacin (41%).Conclusion: The rates of isolation and drug resistance of K. pneumoniae in PICU have significantly increased over 7 years. Careful antibiotic use, infection control strategies, and appropriate antibiotic combinations are crucial in addressing this problem.Keywords: pediatric intensive care unit, Klebsiella pneumoniae, bacterial drug resistance
