耐碳青霉烯类肺炎克雷伯菌的耐药性及危险因素分析

Drug resistance of carbapenem-resistant Klebsiella pneumoniae and risk factors

目的研究耐碳青霉烯类肺炎克雷伯菌(Carbapene-resistant klebsiella pneumoniae,CRKP)的耐药情况及临床感染的危险因素,为CRKP的防控提供依据。方法收集天津市第三中心医院2016年1月-2018年12月CRKP感染患者160例为CRKP组,按1∶2比例配对选取同期同病区320例对碳青霉烯类敏感的肺炎克雷伯菌(Carbapenem-susceptible kpneumoniae,CSKP)患者为CSKP组,进行耐药情况的比较,对CRKP感染的相关因素进行单因素分析,并进行多因素的Logistic回归分析。结果两组患者对呋喃妥因耐药率差异无统计学意义,CRKP组对其余抗菌药物耐药率均高于CSKP组(P<0.05)。单因素分析显示,感染前住院天数>14 d、ALB<35 g/L、导尿管置入、深静脉置管、气管插管、抗菌药物使用时间>14 d、抗菌药物种类>3种、碳青霉烯类、糖肽类的使用均与CRKP感染有关(P<0.05)。多因素的Logistic回归分析显示:ALB<35 g/L、置入导尿管、应用抗菌药物种类>3种为CRKP的独立危险因素(P<0.05)。结论针对其危险因素,改善患者营养状态,合理应用抗菌药物,减少有创操作,增强感染监测,严格实施消毒隔离,从而对CRKP进行有效的防控。

OBJECTIVE To investigate the drug resistance and the risk factors in carbapene-resistant Klebsiella pneumoniae(CRKP) infection, so as to provide basis for the prevention and control of CRKP. METHODS From Jan. 2016 to Dec. 2018, 160 patients infected with carbapene-resistant K. pneumoniae CRKP in the Third Central Hospital of Tianjin were divided into the CRKP infection group. A 1:2 matched cohort named the CSKP group enrolled 320 patients who were sensitive to penicillium carbapenem-susceptible K. pneumoniae( CSKP) in the same ward during the same period. The drug resistance rate was compared between the two groups. Risk factors in CRKP infection were analyzed by univariate analysis and logistic regression analysis. CONCLUSION The resistance rate to nitrofurantoin between the two groups was not significant. But the drug resistance rate to common antimicrobial agents was significantly higher in the CRKP group than that in the CSKP group(P<0.05). Univariate analysis showed that the risk factors of CRKP infection included hospitalization days before infection >14 d, ALB<35 g/L, catheter implantation, deep vein catheterization, tracheal intubation, time of use of antimicrobial agents >14 d, types of antimicrobial agents >3, carbapenems and glycopeptide(P<0.05).The logistic regression analysis of multiple factors showed that ALB<35 g/L, catheter implantation, and types of antimicrobial agents >3 were independent risk factors of CRKP(P<0.05). CONCLUSION Avoiding the risk factors may prevent and control the occurrence of drug resistance of CRKP, such as the improvement of the nutrient condition of patients, rational use of antibiotics, reducing the inventions, improvement of infection monitors and strict disinfection and isolation management.