CRKP导致的呼吸机相关性肺炎的耐药及药敏特征分析

Analysis of drug resistance and drug sensitivity characteristics of ventilator-associated pneumonia caused by CRKP

目的分析耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumonia,CRKP)导致的呼吸机相关性肺炎的耐药及药敏特征。方法选取2015年10月~2018年3月于我院诊治的耐碳青霉烯类肺炎克雷伯菌患者60例,另选取50例碳青霉烯类敏感肺炎克雷伯菌(carbapenem-sensitive Klebsiella pneumonia,CSKP)患者,参照诊断标准,符合CRKP导致的VAP感染的患者共计35例,作为研究组,CSKP导致的VAP感染患者共计30例,作为对照组,分析CRKP及CSKP患者导致的呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的危险因素及CRKP患者的耐药性及敏感性。结果两组患者在使用抗菌药物时间、种类及机械通气时间上相比,差异具有统计学意义(P<0.05);CRKP对亚胺培南、头孢噻肟、头孢吡肟、头孢他啶、头孢呋辛、头孢克洛、头孢唑啉、氨苄西林、哌拉西林、青霉素及环丙沙星的耐药率均为100.00%;对美罗培南及厄他培南的耐药率和中介率分别为97.14%和2.86%;对磷霉素敏感率为14.29%、阿米卡星敏感率为2.86%、复方磺胺甲噁唑敏感率为77.14%、替加环素敏感率为100.00%。结论 CRKP导致的呼吸机相关性肺炎与应用抗菌药物时间及种类等因素有关,对替加环素和复方磺胺甲噁唑的敏感率较高,对厄他培南、亚胺培南等碳青霉烯类抗菌药物的耐药率较高,临床医护人员应密切监护,控制感染传播。

Objective To analyze the drug resistance and drug sensitivity of ventilator-associated pneumonia caused by carbapenem-resistant Klebsiella pneumonia(CRKP). Methods 60 patients with carbapenem-resistant Klebsiella pneumoniae in our hospital from October 2015 to March 2018 were enrolled. Another 50 carbapenem-sensitive Klebsiella patients were selected. According to the diagnostic criteria, a total of 35 patients with VAP infection caused by CRKP were selected as study group. A total of 30 patients with VAP infection caused by CSKP were selected as control group. Risk factors for ventilator associated pneumonia(VAP) caused by CRKP and CSKP as well as drug resistance and sensitivity in patients with CRKP were analyzed. Results The difference in the antibacterial drugs time, type and mechanical ventilation time between the two groups was statistically significant(P<0.05). The resistance rate of CRKP to imipenem, cefotaxime, cefepime, ceftazidime, cefuroxime, cefaclor, cefazolin, ampicillin, piperacillin, penicillin and ciprofloxacin were all 100.00%. The resistance rate and intermediate rate of CRKP to meropenem and ertapenem were 97.14% and 2.86%, respectively. Its sensitivity rate to fosfomycin, amikacin, compound sulfamethoxazole and tigecycline was 14.29%, 2.86%, 77.14% and 100.00%. Conclusion The ventilator-associated pneumonia caused by CRKP is related to the time and type of antibiotics. It is sensitive to tigecycline and compound sulfamethoxazole. It has a high resistence rate to ertapenem and imipenem. The clinical medical personnel should closely monitor and control the spread of infection.