ICU下呼吸道肺炎克雷伯杆菌耐碳青霉烯类药物的危险因素研究

The risk factors for carbapenem-resistanee of klebsiella pneumoniae isolated from lower respiratory tract in ICU

目的探讨重症医学科（ICU）下呼吸道感染临床分离出的肺炎克雷伯杆菌对常用抗菌药物的耐药性，并探讨其对碳青霉烯类抗菌药物耐药的危险因素。方法采用回顾性分析方法，分析2013-04～2015—04ICU临床痰液标本中分离的肺炎克雷伯杆菌耐药性及碳青霉烯类耐药肺炎克雷伯杆菌（CRKP）感染的危险因素。结果①肺炎克雷伯杆菌对阿米卡星的敏感率最高，为86．81％，对亚胺培南和美罗培南的敏感率分别为62．5％和62．86％。153株肺炎克雷伯杆菌中，共检出CRKP56株，检出率36．7％。CRKP对阿米卡星的敏感率仍较高，达68．52％，对复方新诺明的敏感率达25％，但对其他抗菌药物的敏感率均小于20％。耐药率严重。②单因素分析发现，肺炎克雷伯杆菌感染前住院天数≥5d、住ICU≥7d、机械通气≥7d、同时存在真菌感染、2周内使用碳青酶烯类抗菌药物、留置尿管、WBC计数〉10．0×10^9／L或〈4．0×10^9／L及高血压病是ICU下呼吸道感染中肺炎克雷伯杆菌对碳青霉烯类抗菌药物产生耐药的危险因素（P〈0．05）。Logistic回归分析发现，住院天数≥5d、2周内使用碳青酶烯类抗菌药物是ICU下呼吸道感染中肺炎克雷伯杆菌耐碳青霉烯类抗菌药物的独立危险因素。结论ICU内肺炎克雷伯杆菌耐药率严重，减少碳青霉烯类抗菌药物的使用，尽量缩短住院时间有利于预防ICU内CRKP所致下呼吸道感染的发生。

Objective To investigate the antibiotic resistance of klebsiella pneumoniae isolated from lower respiratory tract in ICU and the risk factors of carbapenem-resistant, so as to provide reference for making preventive and control measures of carbapenem-resistant klebsiella pneumoniae （CRKP） infection. Methods The klebsiella pneumoniae isolated from sputum samples of patients with lower respiratory tract infection from April 2013 to April 2015 in ICU were cultured to analyze the drug resis- tance and clinical data of those patients who were collected to analyze the risk factors of CRKP infection. Results （~The sensitive rate of Amikacin was the highest, which accounted for 86.81%, followed by imipenem and meropenem which accounted for 62.5% and 62.86%, respectively. Of 153 strains of isolated klebsiella pneumonia, 56 （36.7% ） were CRKP. Among the CRKP isolated, the sensitive rate of Amikacin was the highest, which accounted for 68.52%, followed by cotrimoxazole, which accounted for 25%. The resistant rates of other antimicrohial agents were less than 20%. The resistance was very serious. （2）Univariate analysis revealed that length of hospital stay≥5 days, ICU occupancy≥7 days, the length of mechanical ventilationS7 days, use of urinary catheterization, use of Carbapenem antibiotics within 2 weeks, WBC 〉 10.0×10^9/L or 〈 4.0×10^9/L, the presence of fungal infection at the same time and hypertension were risk factors for carbapenem-resistant. Logistic regression analysis revealed that length of hospital stay≥5 days and use of carbapenem antibiotics within 2 weeks were independent risk factors for CRKP infection. Conclusion The resistance of klebsiella pneumoniae was very serious in ICU. Reducing the use of carbapenem antibiotics and shortening the length of hospital stay may help to prevent the lower respiratory tract infections caused by CRKP.