耐碳青霉烯类抗生素肺炎克雷伯菌感染的特征及易感因素分析

Clinical Characteristics and Susceptibility Factors of Carbapenem-Resistant Klebsiella Pneumonia Infection

目的分析耐碳青霉烯类抗生素肺炎克雷伯菌(CRKP)感染的临床特征及易感因素。方法收集2011年至2015年医院住院患者的非重复CRKP 51株,进行临床特征总结、药物敏感性试验,分析耐药情况及易感因素。结果按照占比从高到低排序,菌株来源病区分别为重症加强护理病房(ICU)、感染科、呼吸内科、胸心外科、神经内科、骨科及血液科标本类型分别为痰液、尿液、血液、胆汁及创面、脓液。头孢菌素类、青霉素类、美罗培南和环丙沙星耐药率高达100.00%(51/51),其余抗菌药物耐药率从高到低排序分别为头孢呋辛、庆大霉素、复方新诺明、四环素、氨曲南、左旋氧氟沙星、妥布霉素;根据Logistic回归分析法评价可知,入住ICU、住院时间≥7 d、机械通气时间≥5 d、合并糖尿病及多种抗生素联用均为影响患者感染的危险因素。结论 CRKP具有严重的多重耐药情况,其耐药性可能与呼吸机使用及产超广谱β-内酰胺酶(ESBLs)存在一定相关性。

Objective To analyze the clinical characteristics and susceptibility factors of carbapenem-resistant Klebsiella pneumonia（ CPKP） infection. Methods A total of 51 non-repeated CRKP strains from hospitalized patients from 2011 to 2015 were collected,and the clinical characteristics were summarized, the antimicrobial susceptibility tests were carried out, and drug resistance and susceptibility factors were analyzed. Results According to the accounting order from high to low order, the source areas of the strains were ICU,Department of Infectious Diseases,Department of Respiratory Medicine,Department of Cardiothoracic Surgery,Department of Neurology and Department of Hematology. The types of strains ranked from high to low in proportion were sputum,urine,blood,bile,wound and pus. The resistance rates of cephalosporins, penicillins, meropenem and ciprofloxacin were up to 100. 00%（ 51/51）. According to the order of the rate of drug resistance,the other antibacterial drugs were were cefuroxime,gentamicin,compound sulfamethoxazole,tetracycline,aztreonam,levofloxacin, and tobramycin. The Logistic regression analysis showed that, ICU stay, hospitalization time ≥ 7 d, mechanical ventilation time≥5 d,diabetes mellitus and combination of various antibiotics were the risk factors of infection in patients. Conclusion CRKP has severe multi drug resistance,and the drug resistance may be related to the use of ventilator and production of ESBLs.