ICU患者耐碳青霉烯类肺炎克雷伯菌医院感染危险因素分析

Risk factors for carbapenem-resistant Klebsiella pneumoniae infection in ICU patients

目的探讨ICU患者发生耐碳青霉烯类肺炎克雷伯菌医院感染危险因素,制定感染预防干预措施,以期减少医院感染的发生。方法调查上海某三级综合医院2013-2014年ICU内发生的耐碳青霉烯类肺炎克雷伯菌医院感染患者共11例(病例组),采用病例对照方法展开研究,按1∶3配对,对照组选择2013-2014年入住该医院ICU>48h且未发生耐碳青霉烯类肺炎克雷伯菌医院感染的患者共33例,对ICU发生耐碳青霉烯类肺炎克雷伯菌医院感染的危险因素进行分析。结果病例组患者使用过碳青霉烯类抗菌药物占90.91%,对照组患者中占45.45%,两组比较差异有统计学意义(P<0.05);病例组患者与耐碳青霉烯类肺炎克雷伯菌感染患者住同病区平均天数12d,对照组患者为4.45d,结果差异有统计学意义(P<0.05);碳青霉烯类抗菌药物的使用尤其长时间使用,以及长时间与耐碳青霉烯类肺炎克雷伯菌患者住同病区,是ICU内发生耐碳青霉烯类肺炎克雷伯菌医院感染的危险因素。结论应适当调整碳青霉烯类抗菌药物选取以及使用时长,针对病区内耐碳青霉烯类肺炎克雷伯菌感染患者做好有效医院感染预防控制措施,以减少耐碳青霉烯类肺炎克雷伯菌医院感染的发生,延缓耐碳青霉烯类肺炎克雷伯菌的传播。

OBJECTIVE To explore the risk factors for nosocomial inferction in ICU patients due to carbapenem-resistant Klebsiella pneumoniae and put forward intervention measures so as to reduce the incidence of nosocomial infection.METHODS A total of 11 patients with carbapenem-resistant K.pneumoniaeinfection,who were treated in the ICU of a tertiary hospital in Shanghai from 2013 to 2014,were assigned as the case group,a case-control study was conducted,in a 1：3ratio,totally 33 patients without carbapenem-resistant K.pneumoniaeinfection who were hospitalized in the ICU of the hospital for more than 48 hours from 2013 to 2014 were set as the control group.The risk factors for the nosocomial infection due to the carbapenem-resistant K.pneumoniae were analyzed.RESULTS The patients who were treated with carbapenems accounted for 90.91% in the case group,45.45%in the control group,with significant difference（P〈0.05）.The mean duration of stay in the same ward of the patients with carbapenem-resistant K.pneumoniaeinfection was 12 days in the case group,4.45 days in the control group,with significant difference（P〈0.05）.The use of carbapenems especially the use for a long time period and the stay in the same ward especially for a long time period were the risk factors for the nosocomial infection due to the carbapenem-resistant K.pneumoniae.CONCLUSION It is necessary to appropriately adjust the carbapenems antibiotics administration and take effective prevention measures for the patients with carbapenem-resistant K.pneumoniaeinfection so as to reduce the incidence of the nosocomial infection due to the carbapenem-resistant K.pneumoniae and retard the spread of the carbapenem-resistant K.pneumoniae.