A possible link between improper use of carbapenems and prevalence of carbapenem-resistant Klebsiella Pneumoniae in a hospital

Abstract

Background: The emergence of carbapenem-resistant Enterobacteriaceae made the treatment difficult, which has become a major issue of public health. A sharp increase of carbapenem-resistance rate in Klebsiella pneumoniae was observed in a maternity and child health care hospital in Zunyi, China, in 2014.To investigate the cause and epidemiology of the carbapenem-resistant Klebsiella pneumoniae (CRKp) in the affected hospital.Methods: In 2015-2016, CRKp isolated from all the clinical samples were analyzed to identify the carbapenem-resistance genes. They were then fingerprinted in order to determine their genetic relationship. Clinical data such as usage of imipenem in 2012-2016 and the nosocomial infection surveillance data were analyzedResults: Thirty five isolates of CRKp out of 4328 various pathogens were obtained and blaNDM-1 was identified to be the most common resistant gene present in the CRKp isolates. The fingerprint analysis identified 15 major clusters of CRKp isolates. The bacteria with close proximity relationship tended to be from the same wards. However, a few CRKp isolates from different wards were found to be genetically highly related. The clinical data showed a significantly higher usage of carbapenems in 2012-2013, before the CRKp rate sharply increased in 2014. The nosocomial infection surveillance showed unexpected high rate of failures to meet the requirement of the hospital environment hygiene and hand hygiene in the neonatal ward.Conclusion: The increasing isolation rate of CRKp was associated with poorly regulated usage of carbapenems, impropriate medical practices and the poor hospital environmental hygiene and hand hygiene.