Phân bố carbapenemase và phác đồ kháng sinh ở bệnh nhân nhiễm Klebsiella spp. kháng carbapenem

Abstract

A retrospective cross-sectional study was conducted on 78 patients infected with carbapenem-resistant Klebsiella spp. (CRK) with positive carbapenemase test results at 108 Military Central Hospital from October 2025 to June 2026 to investigate microbiological characteristics, carbapenemase distribution, and antibiotic usage patterns. The results showed that most patients were treated in the intensive care unit (73.1%), with respiratory infections predominating (60.0%). A total of 55.1% of strains carried a single carbapenemase enzyme, while 44.9% carried ≥ 2 types of enzymes. The combination of OXA-48-like + NDM accounted for the highest proportion (42.3%), followed by OXA-48-like alone (35.9%). Metallo-beta-lactamase (MBL) producers accounted for 50.0%. The isolated CRK strains showed the highest susceptibility rates to amikacin (78.9%) and ceftazidime/avibactam (33.9%), with over 80% exhibiting intermediate resistance to colistin. Following the release of enzyme test results, 74.4% of patients had their treatment regimens adjusted (at an average of 1.3 days); the usage rate of ceftazidime/avibactam increased from 12.8% to 55.1%, aztreonam increased from 1.3% to 12.8%, while meropenem decreased from 52.6% to 26.9%. The MBL-producing group was prescribed aztreonam (25.6%) and colistin (28.2%) at higher rates than the non-MBL-producing group. The proportion of patients with improved clinical outcomes at discharge (cured or improved) reached 70.5%. In conclusion, this study demonstrates a high rate of MBL-producing CRK (50.0%). Rapid carbapenemase detection assays facilitate timely adjustments to targeted antibiotic regimens (such as combining ceftazidime/avibactam and aztreonam for the MBL-producing group), thereby improving treatment efficacy and optimizing antimicrobial stewardship.