骨科医院感染耐碳青霉烯类肺炎克雷伯菌耐药性及危险因素分析

Analysis of risk factors and drug resistance of carbapenem-resistant Klebsiella pneumonia infection in orthopaedic hospital

目的探讨骨科医院感染耐碳青霉烯类肺炎克雷伯菌(CRKP)的耐药性及其导致医院感染的危险因素。方法回顾性研究2015年1月-2018年12月某院收治的146例肺炎克雷伯菌培养阳性患者的临床资料,根据药敏结果将患者分为CRKP组和CSKP组,比较两组患者对常用抗菌药物的耐药情况,CRKP菌株医院感染的危险因素。结果146例患者中CRKP菌株42例和CSKP菌株104例。CRKP对大部分常用抗菌药物的耐药率高于CSKP(P<0.05)。近3个月使用多因素Logistic分析结果显示,多发伤、入住ICU、留置至少一种插管、近3个月使用碳青霉烯类、近3个月使用三代或四代头孢菌素、住院时间>30 d是CRKP感染的独立危险因素。结论骨科患者CRKP耐药情况严重,应采取有效的防控措施,降低CRKP菌株感染的风险。

Objective To investigate the drug resistance of carbapenem-resistant Klebsiella pneumonia(CRKP)in orthopaedic hospital and the risk factors of hospital infection.Methods The clinical data of 146 patients with positive culture of Klebsiella pneumonia in a hospital from January 2015 to December 2018 were retrospectively analyzed.According to the results of drug sensitivity,the patients were divided into the case group(CRKP)and the control group(carbapenem-sensitive Klebsiella pneumonia,CSKP).Drug resistance to commonly used antibiotics was compared between the two groups of patients.Logistic regression analysis was used to identify the risk factors of hospital infection induced by CRKP.Results Among the 146 patients,42 were CRKP strains and 104 were CSKP strains.The resistance rate of CRKP strains to most commonly used antibacterial drugs was higher than that of CSKP strains(P<0.05).Multivariate Logistic regression analysis showed that multiple injuries,admission in ICU,indwelling at least one kind of intubation tube,using carbapenems in recent 3 months,using third-or fourth-generation cephalosporins in recent 3 months,and length of hospital stay>30 d were the independent risk factors for CRKP infection.Conclusion The drug resistance of CRKP is serious in orthopaedic patients,effective prevention and control measures should be taken to reduce the risk of CRKP infection.