广泛耐药肺炎克雷伯菌感染的流行病学调查和危险因素分析

Epidemiological survey and risk factor analysis of extensively drug-resistant Klebsiella pneumoniae infections

目的分析广泛耐药肺炎克雷伯菌(extensively drug-resistant Klebsiella pneumoniae, XDR-KP)的分子流行病学特点及感染危险因素。方法收集2012年1月至2015年12月重庆医科大学附属第一医院临床标本中分离的39株XDR-KP菌株作为病例组,同时按1:2的比例配对随机选择78例同期非XDR-KP菌株作为对照组,采用卡方检验和Logistic回归模型对患者病例资料进行相关危险因素分析,并采用脉冲场凝胶电泳(PFGE)进行分子流行病学分析。结果多因素Logistic回归分析显示,入住ICU(OR:3.01,95%CI:1.12-8.07, P=0.029)、内置引流管(OR:3.24, 95%CI:1.11-9.45, P=0.032)和碳青霉烯类抗生素使用(OR:5. 08,95%CI:1.42-18.16,P=0. 012)是导致XDR-KP感染的独立危险因素;PFGE结果显示,39株广泛耐药肺炎克雷伯菌可分为35个克隆型别,其中有4个克隆型别分别由2株紧密相关的菌株组成,但均来自不同科室,提示实验菌株不存在各科室间的克隆传播现象。结论 XDR-KP感染形势严峻,加强ICU病房的监管和防控,减少相关侵入性操作及合理使用碳青霉烯类抗生素是防止广泛耐药菌株的产生与流行的有效措施。

ObjectiveTo analyze the epidemiological characteristics and risk factors of extensively drug-resistant Klebsiella pneumoniae （XDR-KP） infections. MethodsA total of 39 strains of XDR-KP isolated from our hospital during January 2012 and December 2015 were collected and assigned into the disease group. And another 78 strains （at a ratio of 1：2） of non-XDR-KP bacteria randomly collected in same duration were assigned into the control group. Chi-square test and logistic regression analysis were performed to evaluate the related risk factors. And the molecular epidemiology was characterized by pulsedfield gel electrophoresis （PFGE）. ResultsMultivariate logistic regression analysis showed that ICU admission （OR=3.01, 95%CI： 1.12-8.07, P=0.029）, drainage tube （OR=3.24, 95%CI： 1.11-9.45, P=0.032） and carbapenems exposure （OR=5.08, 95%CI： 1.42-18.16, P=0.012） were the independent risk factors of XDR-KP infection. PFGE results showed that the 39 strains of XDR-KP were divided into 35 clone types. Moreover, 4 clone types were composed of 2 closely related strains, but these strains were collected from different wards, indicating that no transmitting phenomenon was observed among the investigated isolates among different wards. ConclusionThe situation of XDR-KP infection is fairly severe. Strengthening the supervision and control of ICU wards, fewer invasive operations and reasonable use of carbapenem antibiotics would be necessary to prevent the occurrence and prevalence of XDR-KP.