医院内泛耐药肺炎克雷伯菌定植及感染风险因素调查与控制

Colonization and infection of pandrug resistant Klebsiella pneumoniae and risk factors thereof in in-patients

目的调查医院内泛耐药肺炎克雷伯菌（Pandrug-resistant isolates of Klebsiella pneumoniae）定植、感染状况，对感染控制措施进行评价。方法对2008年1月～2011年12月北京协和医院住院患者的泛耐药肺炎克雷伯氏菌定植、感染进行前瞻性调查，对危险因素进行分析；对感染控制措施进行评价。结果共发现泛耐药肺炎克雷伯菌阳性检出者37例，阳性检出者涉及全院15个病区，加强医疗及老年病区相对集中59．45％（22／37），新生儿2例，65岁以上的老年人56．76％（21／37）。全部患者具备1项以上泛耐药肺炎克雷伯菌感染风险因素。初次检出标本主要来源依次为痰（15／37）、血液（10／37，3例来自中央静脉留置者）、尿（3／37）、创面泌物（3／37）、直肠拭子（2／37）、胆汁（1／37）、PTCD引流（1／97）、导管尖（1／37）、其他引流液（1／37）。37例泛耐药肺炎克雷伯菌阳性检出病例中，8例为定植，其余29例为临床感染并进行治疗。阳性检出菌株体外药敏对阿米卡星和，或米诺环素外其他药物全部耐药，对阿米卡星敏感性为60％，对米诺环素敏感性为57％。29例感染者米诺环素治疗，有效率72．4％（21／29）。37例患者死亡14例（病死率37_8％，归因病死率21．6％o未发生泛耐药肺炎克雷伯菌院内水平传播。结论泛耐药肺炎克雷伯菌定植、感染者的病死率高；老年人、入院前半年内曾使用抗菌药物、留置导管等可能是泛耐药肺炎克雷伯菌定植、感染的主要危险因素；应加强抗菌药物应用的管理，强化医院感染控制措施（特别是接触隔离）在加强医疗部门的实施和监督。

Objective To investigate the colonization and infection of pandrug resistant Klebsiella pneumoniae and risk factors thereof in in-patients. Methods The isolated strains of Klebsiella pneumoniae underwent resistant tests 2008-2011. Results Klebsiella pneumoniae was isolated in the sputum, blood, urine, wound secretion, bile, rectum swab, catheter tip, or drainage fluid of 37 patients, 35 adults and 2 newborns, 56.76% being over 65 （21/37）, admitted to all 15 wards, 59.45% （22/37） being in the ICU and ward of geriatric diseases. The detectable rate was. Eight of the 37 cases were cases of colonization, and 29 were infection cases. The detectable number was increasing year by year. The isolated strains were resistant to all antimicrobial drugs except amikacin and/or minocyeline with the sensitivity of 60% to amikacin and 57% to minocyclin. 29 cases were treated with minocyclin with an effective rate of 72.4% （21/29）. 14 of the 37 patients died with a mortality of 37.8% and an attributable mortality due to this bacterium of 21.6%. All 37 patients had been treated with antibiotics within 6 months before admission. Contact isolation was adopted in the wards with high isolation rates of this bacterium. No horizontal transmission occurred in the hospital. Conclusion The mortality of the patients with colonization or infection of pandrug resistant Klebsiella pneumoniae is high. Anti-microbial agents used within 6 months before admission and indwelling of catheters may be the risk factors. Strengthening the control of nosocomial infection is effective.