YẾU TỐ NGUY CƠ NHIỄM KLEBSIELLA PNEUMONIAE KHÁNG CARBAPENEM Ở BỆNH NHÂN VIÊM PHỔI BỆNH VIỆN TẠI BỆNH VIỆN NGUYỄN TRI PHƯƠNG

Abstract

Introduction: Hospital-acquired pneumonia (HAP) represents a significant global healthcare burden. According to the 2022 report from the Ministry of Health, Klebsiella pneumoniae is the leading causative agent of HAP, with carbapenem resistance rates reaching 50%. Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections pose substantial challenges to treatment and are associated with increased mortality rates. Study Objective: To identify risk factors associated with CRKP infection in patients with HAP caused by Klebsiella pneumoniae. Materials and Methods: A cohort study was conducted on 87 patients diagnosed with HAP at Nguyen Tri Phuong Hospital, with positive Klebsiella pneumoniae cultures from sputum or bronchoalveolar lavage and available antimicrobial susceptibility testing. Data were analyzed using SPSS version 25. Risk factors for CRKP were evaluated through univariate and multivariate regression analyses. Results: Among the 87 patients, the mean age was 71.7 ± 13.8 years, with 55.2% being male. The CRKP prevalence was 56.3% (49/87). The CRKP group exhibited resistance to most commonly used antibiotics (>90%). Factors associated with CRKP included prior ICU admission (20.4% vs. 2.6%), carbapenem use (55.1% vs. 18.4%), quinolone use (66.0% vs. 39.5%), corticosteroid use (59.2% vs. 36.8%), and urinary catheterization (59.2% vs. 23.7%) (p < 0.05). Multivariate analysis identified prior ICU admission [aOR = 13,60  (95% CI: 1,01 - 183,23)], carbapenems use [aOR = 5,52 (95% CI: 1,37 - 22,31)], Charlson comorbidity index ≥3 [aOR = 7,99 (95% CI: 1,59 - 40,06)] as independent risk factors for CRKP. Conclusion: Klebsiella pneumoniae is a significant pathogen in HAP, with a high carbapenem resistance rate (56.3%). Prior ICU admission, carbapenem use and Charlson comorbidity index ≥3  are independent risk factors for CRKP infection.