医院内肺炎克雷伯菌肺炎危险因素及细菌耐药性分析

Analysis on risk factors and antibiotic resistance of nosocomial pneumonia caused by klebsiella pneumoniae

[目的]探讨医院内肺炎克雷伯菌肺炎的危险因素及该菌对抗生素的耐药情况,为防控医院内肺炎克雷伯菌肺炎的爆发流行及临床合理使用抗生素提供依据。[方法]采用病例对照研究方法,对我院4年监测的103例医院内肺炎克雷伯菌肺炎患者的8个危险因素进行调查分析,并将患者痰培养的116株肺炎克雷伯菌进行药敏分析。[结果]医院内肺炎克雷伯菌肺炎占医院内下呼吸道感染的8.59%。内科发病率为0.21%,高于外科发病率0.12%(P<0.05)。气管插管与切开、不合理使用抗生素、住院时间长是医院内肺炎克雷伯菌肺炎的主要危险因素。肺炎克雷伯菌耐药率较高的抗生素依次为氨苄西林、头孢唑啉、头孢呋辛、氨苄西林/舒巴坦。2年间头孢他啶的耐药率由21.3%上升至81.8%,头孢哌酮的耐药率由39.3%上升至72.7%。三代头孢菌素的滥用是肺炎克雷伯菌产生耐药性的重要因素之一。[结论]严格无菌操作,缩短住院时间,合理使用抗生素,特别是合理使用三代头孢菌素,是防止耐药株产生、控制和降低医院感染的关键。

[ Objective] To explore the risk factors of pneumonia caused by Klebsiella pneumoniae （ K. pneumoniae） and the antibiotic resistance of the bacteria to obtain evidence for preventing outbreak of pneumonia caused by K. pneumoniae in hospitals to guide clinical practice in antibiotics application. [ Methods ] Based on the 4 - year surveillance database, a case control study was conducted to analyze 103 cases on 8 risk factors with nosocomial pneumonia caused by K. pneumonia. Antimicrobial susceptibility testing was carried out in 116 strains of K. pneumoniae isolated from sputum culture specimens. [ Results] Patients with pneumonia caused by K. pneumoniae accounted for 8.59% of hospitalization for lower respiratory tract infections, in which a higher incidence was observed among the patients from department of internal medicine than those from department of surgery （ P 〈0. 05 ）. The main risk factors were tracheal intubation and tracheal incision,unreasonable using antibiotics and long time hospitalization. Ampicillin had the highest resistant rate to K. pneumoniae isolates, followed by ampicillin, cefazolin, cefuroxime,and ampicillin/sulbactam. The resistant rate increased from 21.3% to 81.8% for ceftazidime and from 39.3% to 72.7% for cefoperazone during a period of 2 years. The abuse of third - generation cephalosporins was one of the most important factors in inducing the resistance to K. pneumoniae. [ Conclusion] Strict aseptic procedures, shortening the hospitalized duration, appropriate use of antibiotics, particularly the third - generation cephalosporirts is essential to prevent occurrence of drug resistance, prevent and control nosocomial infections.