Different induction effects of antibiotic on Klebsiella pneumoniae and Escherichia coli: a retrospective study from China

Abstract Background: One of the main factors leading to Carbapenem-resistant Enterobacteriaceae (CRE) is antibiotics usage. The main objective of this study was to assess the correlation between antibiotic use and carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Escherichia coli (CREC) induction by antibiotics.Methods: A retrospective study was conducted including patients with Klebsiella pneumoniae (KP) and Escherichia coli (EC) from January 2017 to December 2020. Kaplan-Meier analysis and Cox proportional hazard model were used to estimate the hazard of CRE, while restricted cubic spline regression was used to visualize the hazard of CRE by antibiotics at different doses.Results: 2056 patients with KP and 3243 patients with EC were included. Survival analysis indicated that carbapenem, lactamase inhibitors and quinolones were associated with higher 30-day CRKP hazards than other antibiotics (χ2=33.670, P<0.001). Further restricted cubic spline regression analysis found that the hazard of CRKP induction decreased with the increase dose of lactamase inhibitors, but there was no significant change in that with the increase dose of quinolones. Moreover, there was an obvious characteristic of "parabolic curve" for the hazard of CREC induction due to lactamase inhibitors, and the hazard value gradually increased with the dose, reached the maximum at 24g, and then gradually decreased from 26g.Conclusions: Lactamase inhibitors had different drug resistance inducing effects on CRKP and CREC. Rational use of antibiotics should be implemented according to the characteristics of microorganism.