重症监护室患者耐碳青霉烯类肺炎克雷伯菌感染危险因素分析

Related risk factors for carbapenem-resistant Klebsiella pneumonia infection in ICU patients

目的:了解重症监护室(ICU)中导致肺炎克雷伯菌感染患者耐碳青霉烯类抗菌药物的危险因素,为减少耐药菌的产生提供依据,以减少医院感染的发生。方法:收集某院2017—2018年ICU内经细菌培养鉴定为肺炎克雷伯菌的菌株,按药敏试验结果分为耐碳青霉烯肺炎克雷伯菌组(CRKP组,43例)和非耐碳青霉烯肺炎克雷伯菌组(KP组,109例)。统计每例患者基本情况、感染部位、住院时间、手术、首次检出阳性前抗菌药物使用情况等,分析其与耐碳青霉烯类肺炎克雷伯菌产生的相关性。结果:2组中均是痰标本中分离的占首位,其次是血液、尿液以及创面分泌物等。CRKP感染危险因素的单因素分析可见,患者高龄(P=0.032),合并慢性肾功能不全(P=0.019)、恶性肿瘤(P=0.024),患者机械通气时间、ApacheⅡ评分、感染部位个数是感染CRKP的危险因素(P<0.05)。首次检出CRKP/KP前,患者接受碳青霉烯类或者喹诺酮类药物治疗(P<0.001)是CRKP感染的危险因素。非线性Logstic回归分析显示,患者年龄、住院时间、合并恶性肿瘤、感染部位个数、机械通气时间、ApacheⅡ评分,接受碳青霉烯类、喹诺酮类治疗为CRKP感染的独立危险因素(P<0.05)。结论:应进一步规范碳青霉烯类及喹诺酮类药物的使用,同时针对危险因素高的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 identify risk factors for nosocomial infection of patients in ICU due to carbapenem-resistant Klebsiella pneumonia(CRKP) in ICU, and put forword intervention measures so as to reduce the incidence of nosocomial infection.METHODS The strains identified as Klebsiella pneumoniae by bacterial culture in ICU of the Second Affiliated Hospital of Nanjing Medical University from 2017 to 2018 were collected and divided into carbapenem-resistant Klebsiella pneumoniae group(CRKP group, 43 cases) and non-carbapenem-resistant Klebsiella pneumoniae group(KP group, 109 cases) according to the results of drug sensitivity test.The basic situation of each patient, infection site, length of hospital stay, surgery, and use of antibacterial drugs before the first positive detection were counted to analyze their correlation with the production of carbapenem-resistant Klebsiella pneumoniae.RESULTS The sputum samples of the two groups were separated first, followed by blood, urine and wound secretion.Univariate analysis of risk factors for CRKP infection showed that advanced age(P=0.032), chronic renal insufficiency(P=0.019), and malignant tumors(P=0.024), and duration of mechanical ventilation, ApacheⅡ score, and number of infection sites were risk factors for CRKP infection(P<0.05).Patients receiving carbapenems or quinolones before the first detection of CRKP/KP(P<0.001) were a risk factor for CRKP infection. Nonlinear logistic regression analysis showed that age, length of hospital stay, combined malignant tumors, number of infection sites, duration of mechanical ventilation, Apache Ⅱ score, and receiving carbapenems and quinolones were independent risk factors for CRKP infection(P<0.05).CONCLUSION The use of carbapenems and quinolones should be further standardized, and effective nosocomial infection prevention and control measures should be done for patients with high risk factors in order to reduce the occurrence of carbapenem-resistant Klebsiella pneumoniae nosocomial infection and delay the transmission of carbapenem-resistant Klebsiella pneumoniae.