ICU患者耐碳青霉烯类肺炎克雷伯菌感染的耐药表型及相关因素分析

Analysis of drug resistance phenotype,mechanism and related factors of carbapenem resistant Klebsiella pneumoniae infection in patients with ICU

目的:探究ICU患者耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的耐药表型及相关因素。方法:选取2017年10月~2019年10月90例肺炎克雷伯菌感染的ICU住院患者,分离出耐碳青霉烯类37株,分析CRKP的药敏结果,对CRKP感染患者的一般资料进行的单因素及多因素分析。结果:37株CRKP的药敏结果显示,除对磺胺甲噁唑和阿米卡星耐药率稍低一些分别为56.76%和75.68%外,对其他已检测抗菌药物的耐药率均在90.00%以上。多因素Logistic回归分析显示,患者感染部位个数≥2个、使用碳青霉烯类为CRKP感染的独立危险因素。结论:CRKP对磺胺甲噁唑和阿米卡星耐药率较低,CRKP感染的独立危险因素包括同时携带碳青霉烯酶基因;患者感染部位个数≥2个以及使用碳青霉烯类抗菌药物。

Objective To explore the the resistance phenotype,resistance mechanism and related factors of carbapenem-resistant Klebsiella pneumoniae infection in ICU patients.Methods From October 2017 to October 2019,37 strains of carbapenem resistant to carbapenem were isolated from 90 inpatients with Klebsiella pneumoniae infection.The drug sensitivity results and drug resistance genes of carbapenem resistant Klebsiella pneumoniae were analyzed.Single factor and multivariate analysis of carbapenem resistance of Klebsiella pneumoniae.Results The drug sensitivity of 37 strains of CRKP showed that the drug resistance rate to other antibiotics was above 90.00%,except for sulfamethoxazole and amikacin,respectively.37 strains of CRKP mainly carried carbapenase gene,and the expression rate of KPC and SHV was 100%,followed by CTX-M-1 expression rate of 83.78%.Multivariate Logistic regression analysis showed that the number of infected sites was≥2,and carbapenem was an independent risk factor for carbapenem resistance of Klebsiella pneumoniae.Conclusion The resistance rate of CRKP to sulfamethoxazole and amikacin was low and the carbapenemase gene was carried at the same time,and the number of infected sites was≥2.Carbapenem was an independent risk factor for carbapenem resistance of Klebsiella pneumoniae.