院内感染肺炎克雷伯菌的影响因素及其耐药情况调查

Investigation on the Influencing Factors and Drug Resistance of Klebsiella Pneumoniae Infection in Hospital

【目的】探讨院内感染肺炎克雷伯菌的影响因素及耐药情况。【方法】选取2018年3月至2023年1月本院收治的87例院内感染患者作为研究对象,其中28例院内感染肺炎克雷伯菌患者纳入观察组,59例院内感染鲍曼不动杆菌的患者纳入对照组。比较两组一般资料;分析菌株来源、耐药性及毒力基因;分析院内感染肺炎克雷伯菌的影响因素及耐药情况。【结果】观察组中有21例(75.00%)为混合感染阳性,其中A型(肺炎链球菌)5例(23.81%)、B型(葡萄球菌)4例(19.05%)、C型(流感嗜血杆菌)2例(9.52%)、A型+B型4例(19.05%)、A型+C型2例(9.52%)、B型+C型3例(14.29%)、A型+B型+C型1例(4.76%)。对照组中有26例(44.07%)为混合感染阳性,其中A型6例(23.08%)、B型5例(19.23%)、C型4例(15.38%)、A型+B型3例(8.69%)、A型+C型3例(11.54%)、B型+C型4例(15.38%)、A型+B型+C型1例(3.85%)。两组年龄、性别、住院时间、白蛋白、科室分布、白细胞(WBC)计数及留置导管、侵入性操作、与感染患者住通病区≥1周、终末消毒残缺占比比较,差异无统计学意义(P>0.05);观察组长期使用广谱抗菌药物、合并其他细菌感染≥2种及前期肺炎克雷伯菌定植占比高于对照组(P<0.05)。Logistic回归分析结果:长期使用广谱抗菌药物、合并其他细菌感染≥2种、前期肺炎克雷伯菌定植是患者院内感染肺炎克雷伯菌的危险因素(P<0.05)。28株菌株主要来源于痰液、血液;肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢曲松耐药性最高(100%),肺炎克雷伯菌对替加环素(3.57%)、四环素(7.14%)耐药性最低;28株菌株中高黏液性菌株6株(21.43%)、非高黏液性菌株22株(78.57%),高黏液性菌株拉丝实验阳性率高于非黏液性菌株(P<0.05);高黏液性菌株iroN、rmpA及ybtS毒力基因阳性率高于非黏液性菌株(P<0.05)。【结论】长期使用广谱抗菌药物、合并其他细菌感染≥2种、前期肺炎克雷伯菌定植是患者院内感染肺炎克雷伯菌的危险因素,肺炎克雷伯菌对常见抗菌药物耐药性较为严重。

【Objective】To explore the influencing factors and drug resistance of Klebsiella pneumoniae in hospital acquired infections.【Methods】A total of 87 patients with hospital acquired infections admitted to our hospital from March 2018 to January 2023 were selected as the study subjects.Among them,28 patients with hospital acquired infections of Klebsiella pneumoniae were included in the observation group,and 59 patients with hospital acquired infections of Acinetobacter baumannii were included in the control group.Two sets of general information were compared;Strain source,drug resistance,and virulence genes;The influencing factors and drug resistance of Klebsiella pneumoniae infection in the hospital were analyzed.【Results】In the observation group,21 cases(75.00%)were positive for mixed infections,including 5 cases(23.81%)of type A(Streptococcus pneumoniae),4 cases(19.05%)of type B(Staphylococcus aureus),2 cases(9.52%)of type C(Haemophilus influenzae),4 cases(19.05%)of type A+B,2 cases(9.52%)of type A+C,3 cases(14.29%)of type B+C,and 1 case(4.76%)of type A+B+C.In the control group,26 cases(44.07%)were positive for mixed infections,including 6 cases of type A(23.08%),5 cases of type B(19.23%),4 cases of type C(15.38%),3 cases of type A+B(8.69%),3 cases of type A+C(11.54%),4 cases of type B+C(15.38%),and 1 case of type A+B+C(3.85%).There was no statistically significant difference(P>0.05)in age,gender,length of hospital stay,albumin levels,department distribution,white blood cell count(WBC)and indwelling catheter count,invasive procedures,and the proportion of infected patients staying in the same ward for≥1 week or with incomplete final disinfection between the two groups;The observation group had a higher proportion of long-term use of broad-spectrum antibiotics,combined with at least 2 other bacterial infections,and early colonization of Klebsiella pneumoniae than the control group(P<0.05).The results of logistic regression analysis showed that long-term use of broad-spectrum antibiotics,concurrent infection with≥2 other bacteria,and early colonization of Klebsiella pneumoniae were risk factors for hospital acquired Klebsiella pneumoniae infection in patients(P<0.05).28 strains of bacteria mainly come from sputum and blood;Klebsiella pneumoniae has the highest resistance to piperacillin/tazobactam and ceftriaxone(100%),while it has the lowest resistance to tigecycline(3.57%)and tetracycline(7.14%);Among the 28 strains,6 strains(21.43%)were high mucinous and 22 strains(78.57%)were non high mucinous.The positive rate of high mucinous strains in the wire drawing test was higher than that of non mucinous strains(P<0.05);The positive rates of virulence genes iroN,rmpA,and ybtS in high mucinous strains were higher than those in non mucinous strains(P<0.05).【Conclusion】Long term use of broad-spectrum antibiotics,combined with at least 2 other bacterial infections,and early colonization of Klebsiella pneumoniae are risk factors for patients to be infected with Klebsiella pneumoniae.Klebsiella pneumoniae is more resistant to common antibiotics.