下呼吸道感染肺炎克雷伯菌耐药性及产ESBLs株危险因素分析

Analysis of Drug-resistance of Klebsiella Pneumoniae and Risk Factors of ESBLs Producing Strains Isolated From Lower Respiratory Tract Infection

目的：研究下呼吸道感染肺炎克雷伯菌的耐药性及产ESBLs株感染的危险因素。方法：回顾分析本院2012年分离的257株肺炎克雷伯菌下呼吸道感染患者的流行病学资料,比较产ESBLs和不产ESBLs肺炎克雷伯菌的耐药性。采用病例对照的研究方法,以不产ESBLs肺炎克雷伯菌做为对照组,分析产ESBLs肺炎克雷伯菌感染的危险因素。结果：257株肺炎克雷伯菌中检出产ESBLs菌136株,检出率为52.92%。产ESBLs的肺炎克雷伯菌对测试抗生素的耐药率明显高于不产ESBLs组。20个与产ESBLs感染可能相关的危险因素中,经单因素及多因素Logistic回归分析显示3个为产ESBLs株感染的独立危险因素,即β-内酰胺/β-内酰胺酶抑制剂类（OR=4.117,95%CI=1.763~9.613）、喹诺酮类抗生素（OR=4.132,95%CI=1.942~8.789）和ICU入住〉7 d（OR=4.297,95%CI=1.899~9.726）,而碳青霉烯类抗生素使用是其保护性因素（OR=0.074,95%CI=0.023~0.235）。结论：下呼吸道分离的肺炎克雷伯菌产ESBLs株的检出率高、耐药性强,感染患者病死率高,住院时间长。产ESBLs肺炎克雷伯菌感染具有多个独立危险因素,加强对这些危险因素的控制有助干预防产ESBLs株感染的扩散。

Objective To analyze of drug resistance of Klebsiella pneumoniae isolated from patients with lower respiratory tract infection and the risk factors of ESBLs producing strains. Methods The epidemiological data of patients with 257 strains of drug resistant Klebsiella pneumoniae infection in lower respiratory tract infection in 2012 was retrospectively analyzed. The characteristic of drug-resistance were analyzed in patients of Klebsiella pneumoniae infection with or without producing ESBLs,the risk factors of ESBLs producing strains was analyzed by case-control method. Results The positive rate of ESBLs producing strains was 52. 92%（ 136 /257）. The drug-resistant rate of ESBLs producing strains was significantly higher than that of non-producing strains. Through mono-factor and multi-factor Logistic regression analysis of 20 risk factors correlated with ESBLs producing strains infection,three factors beta-lactam /beta-lactamase inhibitor antibiotics（ OR = 4. 117,95% CI= 1. 763 ~ 9. 613）,quinolones（ OR = 4. 132,95% CI = 1. 942 ~ 8. 789） and ICU occupancy over 7 days（ OR = 4. 297,95%CI = 1. 899 ~ 9. 726）,were the independent risk factors for producing ESBLs. Conclusion The positive rate of ESBLs producing strains was higher in Klebsiella pneumoniae isolated from patients with lower respiratory tract infection,the strains has higher drug resistance. The mortality rate of patients infected with ESBLS producing strains was higher and the hospital stay is long. There were several independent risk factors for Klebsiella pneumoniae infection with producing ESBLs in lower respiratory tract. And the effective control of these factors could be used to prevent from the spead of ESBLs producing strains infection.