ICU肺炎克雷伯杆菌感染患者耐碳青霉烯类及预后的相关因素分析

Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infection in ICU

目的分析ICLU肺炎克雷伯杆菌感染患者耐碳青霉烯类及影响预后的相关因素,为细菌耐药的防治提供临床参考。方法回顾190例ICU肺炎克雷伯杆菌感染患者的细菌培养标本中分离到的肺炎克雷伯杆菌菌株,并结合每例患者的临床资料,统计分析影响肺炎克雷伯杆菌耐碳青霉烯类的相关因素,并对影响患者预后的相关因素进行分析。结果 190例患者的细菌培养标本中共分离到230个肺炎克雷伯杆菌菌株,从痰液标本中分离的菌株占首位(60.00%);耐碳青霉烯类肺炎克雷伯杆菌共分离到130株(56.52%),2009至2011年3年间耐药率呈逐年上升趋势。耐碳青霉烯类肺炎克雷伯杆菌的产生与感染部位数目、碳青霉烯类的使用密切相关(均P<0.05);MODS、恶性肿瘤、急性生理与慢性健康状况评估系统(APACHE)Ⅱ评分、喹诺酮类的使用与肺炎克雷伯杆菌感染患者的预后密切相关(均P<0.05)。结论肺炎克雷伯杆菌耐碳青霉烯类的比例呈逐年上升趋势,其耐药产生与抗生素的使用密切相关。患者的基础疾病情况、APACHEⅡ评分及喹诺酮类的使用与肺炎克雷伯杆菌感染患者的转归相关。

Objective To investigate the risk factors and clinical outcomes of carbapenem-resistant Klebsiella pneumo- niae （CRKP） infections in intensive care unit（ICU）. Methods One hundred and ninety patients with Klebsiella pneumoniae infec- tions admitted in ICU from January 2009 to December 2011 were enrolled in the study. The clinical characteristics, risk factors and outcomes of patients were retrospectively analyzed. Results Two hundred and thirty strains of Klebsiella pneumoniae were isolated, mainly from sputum samples （60%）. Among 190 patients, 113 infected with CRKP and 77 infected with CSKP. Car- bapenem resistant-rate increased annually during this period. The number of infection sites and exposure to carbapenems were independent risk factors for carbapenem-resistance. There was no significant difference in mortality between CRKP and CRSP groups （P 〉0.05）. Multivariate analysis showed that multiple organ dysfunction syndrome （MODS）, malignancy, APACHE II score, and exposure of quinolone were related to mortality of patients. Conclusion The prevalence of carbapenem-resistant Klebsiella pneumoniae is increasing, which is closely related to exposure to carbapenems, and the risk factors for mortality of CRKP infec- tion are associated with basic diseases condition, APACHE II score and exposure to antibiotics.