多重耐药肺炎克雷伯菌感染的危险因素及治疗方案比较

High-risk factors of infection of multidrug resistance Klebsiella pneumonia and analysis of therapeutic effects

目的·分析多重耐药肺炎克雷伯菌(MDR-Kpn)感染的高危因素及不同治疗方案的疗效差异。方法·收集并分离医院内110株MDR-Kpn,进行药敏试验。通过查询电子病历系统,51例患者为MDR-Kpn感染组;同病区相同基础疾病且分离到Kpn的51例患者作为对照组。对MDR-Kpn感染和对照组患者共39项临床指标进行单因素分析,对有统计学意义的变量进行多因素Logistic回归分析。将感染组患者,按治疗结局分为治疗无效组和有效组,比较抗生素使用时间。结果·药敏试验结果显示:110株MDR-Kpn对磺胺类、磷霉素和阿米卡星的敏感性较高。单因素分析结果显示:输血、有创通气、吸痰等12个临床指标为感染高危因素(P<0.05)。有效组(28例)和无效组(23例)在抗生素的使用时间上比较,碳青霉烯类的差异有统计学意义(P=0.025)。结论·控制和消除高危因素对预防及减少MDR-Kpn的感染生长有积极意义;合理使用碳青霉烯类抗生素对预后有利。

Objective · To analyze high-risk factors of infection of multidrug resistance Klebsiella pneumonia （MDR-Kpn） and difference of therapeutic effects for different treatments. Methods · One hundred and ten MDR-Kpn strains were collected from a hospital. K-B slip diffusion method was utilized to detect the drug susceptibility of all the strains. Based on electronic medical records system, MDR-Kpn infected group included 51 patients and control group was picked out, including 51 patients as well （by1：1 ratio basing on the infected group according to the rules of under the same department, similar basic disease and all the patients in the control group isolated with the strain of Kpn）. Thirty-nine clinical information of MDR-Kpn infected and control groups are collected to make single-factor analysis of high risk factors of the infection with MDR-Kpn. Multi-factor analysis was utilized between MDRKpn infected and control groups. The lasting time of different antibiotics used in MDR-Kpn infected patients were made statistics between effective and inefficacy patients. Results · Drug susceptibility test showed that sulfonamide, phosphonomycin and amikacin, were the three most sensitive antibiotics for 110 MDR-Kpn strains. 12 clinical information, such as blood transfusion、sputum suction、invasive ventilation were all high-risk factors for the infection of MDR-Kpn （P〈0.05）. The lasting time during with carbapenems （P=0.025） was statistically different between effective （n=28）and noneffective group （n=23） of MDR-Kpn infection patients. Conclusion · Controlling and eliminating high-risk factors do help to protect and decrease the infection of MDR-Kpn. Using carbapenems correctly has great influence on prognosis.