NGHIÊN CỨU ĐẶC ĐIỂM VIÊM PHỔI CỘNG ĐỒNG DO KLEBSIELLA PNEUMONIA SINH ESBL TẠI BỆNH VIỆN THỐNG NHẤT

Abstract

Background: ESBL Klebsiella pneumonia has become a prominant agent with high antibiotic resistance in community acquired pneumonia (CAP). Objectives: We conducted this cross-sectional descriptive study in Thong Nhat hospital from January 2017 to December 2021 to aim at finding out clinical characterictis and antibiotic resitance of ESBL Klebsiella pneumonia on CAP. Method: We enrolled 146 CAP patients caused by Klebsiella pneumonia were treated at Thong Nhat hospital. They were divided into two groups based on ESBL and non ESBL producing K.pneumonia. Results: There was 55 cases (37,7%) infected by ESBL producing K.pneumonia; 61.6% in men, mean age 80.9 ± 8.5 years. Male accounted for 61.6%, the average age was 80.9 ± 8.5 years. Chest pain, consolidation were more common in ESBL group, whereas tachypnea and dyspnea dominated in non-ESBL group. Consciousness disorder, fever, crackles, multi-lobed lung damage were not different in the two groups of ESBL-producing and non-ESBL-producing K.pneumonia. The ESBL group had an increased PCT (128.5 ± 206.6 versus 67.1 ± 147.5 pg/L), a longer LOS (18.1 ± 11.8 days versus 15.4 ± 9 days, respectively), Mortality rate was 23.6%. Risk factors for an ESBL-producing agent were a history of hospitalization within the previous 30 days, antacid use (OR=2.423; 95% CI 1.2-4.89; p=0.02) consolidation (OR=175; 95% CI 22.5-1360.9; p=0.000) The strongest predictor of mortality was ICU admission (OR=28.33; 95% CI 11.72-71.85; p<0,05), tachypnea > 30 times per minute (OR=2.246; 95% CI 1.049-4.890; p<0.05), ureamia  ≥ 7µmol/L (OR=2.47; 95% CI 1.15-5.33; p=0.02), NTProBNP ≥ 1300pg/L (OR=5.727; 95% CI 2, 37-13,838; p< 0,05, elevated TroponinT ≥ 43 pg/L (OR=2,483; 95% CI 1.125-5.48; p=0.03) ventilatory support (OR 8.86; 95% CI 3.61-21.74; p<0,05). Overall antibiotic resistance rates: ceftazidim 74,1,% vs 38,2%, levofloxacin 70,3% vs 46,5%, ciprofloxacin 69,1% vs 49,5%; ertapenem 24,5% vs 36,2%; imipenem 14,5% vs 32,2%; meropenem 16,7% vs 24%, with p<0.05; still sensitive to Colistin (100%) Conclusions: Klebsiella pneumonia produces ESBL commonly in CAP with high mortality. The main clinical symptoms are dyspnea, chest pain, and consolidation. Risk factors for ESBL include a history of hospitalization within the previous 30 days, antacid use, and consolidation. Mortality increased in patients with ICU admission, ventilatory support, elevated uremia, elevated NTproBNP and elevated Troponin. ESBL K. pneumonia resistanced to most of antibiotic but was still highly sensitive to Colistin.