耐碳青霉烯类肺炎克雷伯菌肠道定植及感染情况分析

Intestinal colonization and infection of carbapenem-resistant Klebsiella pneumoniae

目的了解本院住院患者耐碳青霉烯类肺炎克雷伯菌(CRKP)肠道定植及感染情况,并分析其危险因素,为医院感染的预防控制提供参考。方法通过回顾性研究调查2013-2017年肠道定植/感染CRKP的流行分布及检出患者的临床特征。结果共检出CRKP 327株,其中36株从肠道检出,占11.0%,主要来源于重症医学科和神经外科。36例患者肠道内分离CRKP的定植及感染分别占67%和33%,分析其临床特征发现,1年内反复住院显著提高了患者肠道CRKP定植率。出院仍有47%的患者肠道定植CRKP,手术易造成肠道内CRKP从定植转为感染。结论1年内反复住院和手术是患者肠道定植或感染CRKP的危险因素,应对再次入院的病患进行肠道多重耐药菌筛查,并对筛查阳性的病患实施隔离,加强手术相关抗生素的管理。

Objective To investigate the intestinal colonization and infection of carbapenem-resistant Klebsiella pneumoniae(CRKP)in the patients admitted to our hospital,and to evaluate the risk factors,so as to provide references for the prevention and control of nosocomial infections.Methods A retrospective study was conducted to determine the epidemiological distribution of intestinal colonization and infection of CRKP and the clinical characteristics of patients from 2013 to 2017.Results A total of 327 CRKP strains were detected,including 36 intestinal CRKP strains(11%),mainly from the Department of Critical Care Medicine and Department of Neurosurgery.The intestinal colonization rate and infection rate of CRKP in 36 patients were 67%and 33%,respectively.The clinical characteristics showed that recurrent hospitalization within one year had significantly increased the intestinal colonization rate of CRKP.The intestinal colonization rate of CRKP at discharge was 47%,and surgery could easily cause intestinal infection of CRKP from colonization.Conclusion Recurrent hospitalization and surgery within one year are risk factors for intestinal colonization or infection of CRKP.Intestinal screening of multi-drug resistant bacteria should be performed in re-admitted patients.Patients with positive findings should be isolated,and the management of surgery-related antibiotics should be strengthened.