Economic loss and prognosis of patients with carbapenem-resistant and carbapenem-sensitive Klebsiella pneumoniae infection in intensive care unit

Abstract:

Objective To study the prognosis of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) infection in intensive care unit (ICU), evaluate the economic burden and death risk of CRKP infection, and provide reference for formulating targeted prevention and control strategies. Methods Patients who were isolated Klebsiella pneumoniae from specimens in ICU of a hospital between January 2017 and June 2019 were selected as the research objects, they were divided into CRKP infection group and carbapenem-sensitive Klebsiella pneumoniae (CSKP) infection group by retrospective cohort study, direct hospitalization expense and mortality were analyzed, Kaplan-Meier was adopted to analyze the risk of death, Cox proportional hazards model was used to analyze the influencing factors for risk of death. Results A total of 236 ICU patients were included in analysis, including 175 in CRKP infection group and 61 in CSKP infection group. Lower respiratory tract infection was the major infection in both CRKP infection group and CSKP infection group. Mortality of patients in CRKP infection group was higher than that of CSKP group (28.00% vs 13.11%, P < 0.05). The total hospitalization expense of patients in CRKP infection group was 63 648.34 Yuan higher than that of patients in CSKP infection group (Z=-3.923, P < 0.001), with an increase of 48.76%; the most significant increase was the expense of antimicrobial agents, which increased by 107.78%. There was significant difference in 30-day death risk between ICU patients in CRKP infection group and CSKP infection group(χ²=5.554, P=0.018), but there was no significant difference in 90-day death risk between two groups of patients (χ²=2.603, P=0.107). Compared with CSKP infection group, risk factors for the increase of 30-day death risk in CRKP infection group were circulatory diseases, mechanical ventilation and age of patients. Conclusion CRKP infection increases hospitalization expense and risk of death in ICU patients. More use of antimicrobial agents is the main cause for the increase of hospitalization expense burden, mechanical ventilation is the main cause for the increase of death risk in ICU patients. Clinical application of antimicrobial agents should be rational, the necessity of mechanical ventilation should be evaluated in time, so as to reduce the emergence of antimicrobial-resistant organisms and improve prognosis of patients.