Evaluation of Clinical Distribution and Antimicrobial Resistance of Klebsiella Pneumoniae
Authors: Xie Liping , Wu Zhen’an , Wei Na , Zhang Liang , Tang Jiajian , Wang Hongmei 
Published: August 2024

Purpose:

This paper aims to analyze the clinical distribution and drug resistance
changes of Klebsiella Pneumoniae (KPN) from 2017 to 2021 in the Beijing Hospital of Integrated
Traditional Chinese and Western Medicine to provide a reference for the clinical rational use of
antibiotics.

Methods:

We collected Klebsiella Pneumoniae isolated from various clinical specimens in
2017-2021, analyzed the isolation rate, specimen distribution, and department distribution characteristics
during the five years, and statistically analyzed their drug sensitivity tests and multiple
drug resistance. Zhuhai Deere DL-96 full-automatic microbial analyzer was used for bacterial
identification and drug sensitivity tests. The drug sensitivity test was interpreted according to the
standards recommended by the American Clinical and Laboratory Standards Institute (CLSI).

Results:

A total of 1057 strains of Klebsiella Pneumoniae were identified between 2017 and 2021,
with proportions of 18.6%, 15.7%, 15.4%, 15.1%, and 15.0% in each respective year. Specimen
distribution included sputum (66.0%), urine (17.9%), throat swab (9.4%), secretion (2.4%), pus
(0.7%), venous blood (0.6%), vaginal swab (0.4%), and other sources (2.6%). Distribution by the
department revealed specimens originating from the respiratory department (21.2%), cardiology
department (17.8%), neurology department (13.4%), oncology department (13.0%), nephrology
department (12.2%), acupuncture department (10.1%), and other departments (12.3%). In terms of
drug susceptibility testing, Klebsiella Pneumoniae exhibited high resistance rates to ceftriaxone,
cefotaxime, ceftazidime, and ampicillin/sulbactam, with rates of 50.8%, 46.8%, 46.3%, and 43.6%
respectively. Conversely, resistance rates to minocycline, amikacin, imipenem, and meropenem
were relatively low, at 8.6%, 16.5%, 8.5%, and 9.4% respectively. Resistance rates to cefepime/-
sulbactam and piperacillin/tazobactam were 29.9% and 28.9%, respectively, while cephalosporin
resistance rates ranged from 36.1% to 50.8%. Regarding multidrug resistance, the detection rates
of ESBL-producing Klebsiella Pneumoniae were 8.2%, 10.9%, 4.5%, 10.6%, and 6.4% from 2017
to 2021, with an average detection rate of 7.9%. The detection rates of CR-Kp were 12.1%,
11.7%, 5.8%, 9.9%, and 8.9% respectively, averaging 9.6% over the five-year period.

Conclusion:

The sputum specimen of Klebsiella Pneumoniae exhibits the highest detection rate
among specimen distributions, signifying its significance as a pathogenic bacterium in respiratory
tract infections. Notably, the respiratory department demonstrates the highest detection rate, underscoring
the necessity to enhance the monitoring and management of Klebsiella Pneumoniae infections
in respiratory patients. Over the past five years, our hospital has observed a decreasing trend
in the overall drug resistance rate of Klebsiella Pneumoniae to 17 antibiotics. While imipenem
and meropenem exhibit minimal resistance rates, these carbapenem antibiotics serve as crucial
agents for treating gram-negative bacilli, particularly in critically ill patients, and are thus not recommended
as first-line choices for routine clinical use. Conversely, minocycline, amikacin, ceftazidime/
sulbactam, and piperacillin/tazobactam showcase relatively low resistance rates, enabling
their empirical use based on clinical experience. Combination therapy with other antibiotics
is advised for amikacin. Conclusion: Nevertheless, cephalosporins display a relatively high resistance
rate, necessitating a reduction in their clinical utilization. Regarding multidrug resistance,
the detection of ESBLs-producing Klebsiella Pneumoniae (KP) and Carbapenem-Resistant KP
(CR-Kp) has exhibited a declining trend over the past three years. Despite this positive trend, the
issue of multidrug resistance in Klebsiella Pneumoniae remains severe, with instances of complete
drug resistance reported. Clinicians are urged to judiciously administer antibiotics guided by drug
sensitivity test results and resistance rate variations, restrict the use of broad-spectrum antibiotics,
and manage the emergence and spread of ESBLs-producing and CR-Kp bacteria.