耐亚胺培南肺炎克雷伯杆菌感染危险因素分析

目的分析本地区耐亚胺培南肺炎克雷伯杆菌（IRKP）产生的危险因素，为临床医生合理使用抗菌药物及防止耐亚胺培南菌株的产生提供理论依据。方法收集徐州地区部分医院微生物室分离出的非重复肺炎克雷伯杆菌并收集各菌株的临床信息，统计各菌株对临床常用抗菌药物的耐药情况，选取亚胺培南耐药菌株（IRKP）26株为病例组，亚胺培南敏感菌株（ISKP）81株为对照组，采用单因素分析及多因素logistic归分析，探讨IRKP感染的危险因素。结果收集的肺炎克雷伯杆菌菌株主要分布在ICU、神经外科，标本主要分离自痰液、尿液，收集的肺炎克雷伯杆菌对临床常用抗菌药物的耐药率均较高，除亚胺培南外，其余均〉30％，合并心脑血管疾病、合并COPD／支气管扩张症、之前使用过碳青霉烯类药物是耐IRKP感染的危险因素。结论徐州地区肺炎克雷伯杆菌的耐药现象严峻，减少不必要的有创操作及减少抗菌药物的使用时间等可减少耐亚胺培南菌株的产生。

Objective To analyze the risk factor of imipenem resistant Klebsiella pneumoniae （ IRKP ） in our district in order to provide a theoretical basis for the the rational use of antibiotics and prevent generation of imipenem resistant strains. Methods The non repetitive Klebsiella pneumoniae isolated from the microbiological Department of some hospitals in Xuzhou and the clinical information of each strain was collected. The resistance of each strain to commonly used antibiotics was statistically analyzed.26 strains （ IRKP ） were selected as the case group, imipenem sensitive strain （ ISKP ） of 81 strains as control group, the risk factors of IRKP infection were explored by the single factor analysis and multivariate logistic regression analysis. Results Klebsiella primary strains which mainly isolated from sputum and urine were mainly distributed in the ICU and Department of Neurosurgery. The resistance rate of Klebsiella pneumoniae to clinical common antibiotics was higher, except imipenem, the rest of them were 〉30%, Cardiovascular and cerebrovascular diseases, COPD/with bronchiectasis, previous use of carbapenem drugs were the risk factors of Klebsiella pneumoniae infection. Conclusions The drug resistance of Klebsiella pneumoniae in Xuzhou area is severe, reduce unnecessary invasive operation and reduce the use of antibiotics can reduce the time of imipenem resistant strains.