ICU耐碳青霉烯类肺炎克雷伯菌医院获得性肺炎危险因素分析

Risk factors of hospital-acquired pneumonia due to Carbapenem-resistant Klebsiella pneumonia in the ICU

目的了解耐碳青霉烯类肺炎克雷伯菌(CRKP)医院获得性肺炎(HAP)的危险因素,以制订防控措施,降低医院感染的发生率。方法收集重庆某三甲医院重症医学科(ICU)2014年1月至2016年3月肺炎克雷伯菌感染的HAP患者73例,以27例CRKP感染者为CRKP观察组,46例对碳青霉烯类敏感的肺炎克雷伯菌(CSKP)感染者为CSKP对照组,进行单因素分析和多因素Logistic回归分析。结果单因素分析结果显示,CRKP HAP的危险因素有感染前抗菌药物使用≥7d、感染前使用碳青霉烯类抗菌药物、机械通气天数≥7d、急性生理与慢性健康评分(APACHEⅡ评分)等11项因素。多因素Logistic回归分析结果显示,感染前使用碳青霉烯类抗菌药物、机械通气天数≥7d、APACHEⅡ评分是CRKP HAP的独立危险因素。结论 CRKP HAP的独立危险因素为感染前使用碳青霉烯类抗菌药物、机械通气天数≥7d、APACHEⅡ评分。合理应用抗菌药物,减少机械通气,做好手卫生,是降低CRKP HAP发生率的有效措施。

Objective To understand the risk factors of hospital-acquired pneumonia （HAP） due to Carbapenem-resistant Klebsiella pneumonia （CRKP）,and propose prevention and control measures to reduce the incidence of hospital infection rate.MethodsA total of Klebsiella pneumonia infection 73 patients with HAP,who were treated in the ICU of a tertiary hospital in Chongqing from January 2014 to March 2016 were included.The 27 cases with CRKP were assigned as case group,46 cases with Carbapenemsusceptible Klebsiella pneumonia （CSKP）were included as control group.Univariate and the multivariate Logistic regression analysis was performed for the risk factors.Results Univariate analysis showed that,before infection,the use of antimicrobial agents≥7days,Carbopenems,mechanical ventilation≥7 days,APACHE Ⅱ score,and at least 11 factors were the risk factors for CRKP HAP.Multivariate Logistic regression analysis showed that,Carbapenems,and mechanical ventilation≥7 days before infection and APACHE Ⅱ score was an independent risk factor of CRKP HAP.Conclusion Carbapenems,and mechanical ventilation≥7 days before infection and APACHE Ⅱ score are the independent risk factors for CRKP HAP.Rational use of antibiotics,reducing mechanical ventilation and doing good hand hygiene are effective measures to reduce the incidence of CRKP HAP.