重症监护室耐碳青霉烯类肺炎克雷伯菌感染老年患者的预后探讨

The investigation on the prognosis of ICU patients with carbapenem-resistant Klebsiella pneumoniae infection

目的探讨重症监护室(ICU)耐碳青霉烯类肺炎克雷伯菌感染老年患者的预后疗效。方法回顾性分析2017年8月至2019年7月我院ICU收治的86例肺炎克雷伯菌老年患者临床病例资料,所有患者均采用VITEK系统对细菌进行鉴定以及采用Kirby-Bauer纸片扩散法进行药敏试验,并按照所感染肺炎克雷伯菌是否耐药分为非耐药组(40例)和耐药组(46例),比较不同组患者使用呼吸机天数、入住ICU天数和临床预后效果。结果从痰液中分离出的肺炎克雷伯菌比例(46/86,53.49%)最高,其次为引流液(16/86,18.60%)、血液(12/86,13.95%)、穿刺分泌物(3/86,3.50%)和深静脉导管尖端(9/86,10.46%);肺炎克雷伯菌对美罗培南等耐药率较高,耐药率为53.49%(46/86);与非耐药组(26.11±41.10)d、(38.96±50.75)d比较,耐药组患者呼吸机使用天数(60.75±72.86)d和入住ICU天数(73.41±63.32)d均明显增加(t=2.660、2.756,P=0.003、0.004);非耐药组患者临床有效率57.50%(23/40),明显高于耐药组23.91%(11/46)(χ^2=10.097,P=0.001)。结论ICU耐碳青霉烯类肺炎克雷伯菌感染者呼吸机使用天数、入住ICU时间均较高,临床需严格把握抗菌药物使用指征,积极进行细菌鉴定以及药敏试验,及早确诊肺炎克雷伯菌感染情况,以便为临床诊治提供参考经验。

Objective To investigate the prognosis of intensive care unit(ICU)patients with carbapenem-resistant Klebsiella pneumoniae(CR-KP)infection.Methods Clinical data of 86 elderly patients with KP infection admitted to our hospital from August 2017 to July 2019 were retrospectively analyzed.All patients were identified by the VITEK system and were tested by using the Kirby-Bauer paper diffusion method for drug susceptibility.Based on the existence of CR-KP,patients were divided into the non-resistance group(n=40)and the resistance group(n=46).The number of ventilator days,ICU days and clinical prognosis were compared between the two groups.Results Specimens from sputum had the highest rate of KP isolation(46/86,53.49%),followed by specimens from drainage fluid(16/86,18.60%),blood(12/86,13.95%),puncture wound fluid(3/86,3.50%)and the tip of deep vein catheters(9/86,10.46%).KP had high drug resistance to meropenem,and the drug-resistance rate was 53.49%(46/86).Compared with the non-resistance group,ventilator days and ICU days increased in the drug-resistance group[(60.75±72.86)d vs.(26.11±41.10)d,(73.41±63.32)d vs.(38.96±50.75)d,t=2.660 and 2.756,P=0.003 and 0.004].The clinical effectiveness rate was higher in the non-resistance group than in the drug-resistance group(57.50%or 23/40 vs.23.91%or 11/46,χ^2=10.097,P=0.001).Conclusions ICU patients with CR-KP have a higher number of ventilator days and longer ICU stays than those without CR-KP.In clinical practice,it is necessary to strictly follow the indications for antibiotic use,regularly perform bacterial identification and drug susceptibility tests,and diagnose KP infection as early as possible,in order to provide evidence for clinical diagnosis and treatment.