ICUにおける肺炎桿菌の多変量回帰分析による耐性率と抗菌薬使用量との線形相関の解明

This study investigated the macro-quantitative correlation between Klebsiella pneumoniae resistance rates and concurrent antimicrobial use in the intensive care unit (ICU), to guide treatment for chronic refractory infections caused by this pathogen, by optimizing outcomes for critically ill patients while curbing bacterial resistance spread or transmission.

A retrospective analysis was conducted on the resistance rate of K. pneumoniae and the concurrent use of antimicrobial agents in the ICU. A multiple linear regression model was employed to analyze whether there was an independent linear correlation between the two, and to identify the relevant factors.

936 K. pneumoniae isolates were identified in the ICU between 2020 and 2024, representing 20.45% (936/4,577) of all bacterial isolates recovered from the ICU. The resistance rates to most antimicrobial agents, except for tigecycline and trimethoprim-sulfamethoxazole, exceeded 65%, indicating a severe resistance situation. Multiple linear regression analysis revealed that the resistance rates of K. pneumoniae to imipenem, piperacillin-tazobactam, and ceftazidime were independently linear correlated only with piperacillin-tazobactam defined daily doses (DDDs), with regression coefficients (β) of 0.221, 0.224, and 0.166, respectively. The resistance rates to ceftriaxone, cefoperazone-sulbactam, and ertapenem were positively correlated with piperacillin-tazobactam DDDs. Resistance to cefepime was positively correlated with ceftazidime DDDs. Resistance to tigecycline was positively correlated with meropenem DDDs. Resistance to levofloxacin was negatively correlated with cefoperazone-sulbactam DDDs.

The resistance rate of K. pneumoniae in the ICU is closely related to antimicrobial use. Hospitals should strengthen the regulation of antimicrobial use to delay the emergence of drug-resistant species.