器官移植术后并发耐碳青霉烯类肺炎克雷伯菌医院感染的危险因素

Risk factors for carbapenem-resistant Klebsiella pneumoniae healthcare-associated infection after organ transplantation

目的探讨器官移植术后并发耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染的危险因素,为CRKP的防控提供依据。方法选取某院器官移植病房2014年1月1日—2018年7月31日确诊为CRKP医院感染的54例住院患者为病例组,选择同期该科室确诊为碳青霉烯类敏感肺炎克雷伯菌(CSKP)医院感染的27例住院患者为对照组,采取回顾性病例对照研究方式进行研究。结果两组患者医院感染部位均以下呼吸道(42.59%和48.15%)和手术部位(44.44%和25.93%)为主;除头孢唑林外,两组器官移植术后患者分离肺炎克雷伯菌对其他20种抗菌药物的耐药率比较,差异均有统计学意义(均P<0.05)。单因素分析显示,年龄、送检前抗菌药物使用种类≥3种、送检前有碳青霉烯类使用史、送检前有抗真菌药物使用史均与器官移植术后患者发生CRKP医院感染相关(均P<0.05);多因素分析显示,年龄、送检前抗菌药物使用种类≥3种、送检前有碳青霉烯类使用史是器官移植术后患者发生CRKP医院感染的独立危险因素。结论应针对危险因素加强器官移植术后患者的医院感染防控措施,尤其是碳青霉烯类抗生素的合理使用。

Objective To explore the risk factors for carbapenem-resistant Klebsiella pneumoniae(CRKP)healthcare-associated infection(HAI)after organ transplantation,and provide evidence for prevention and control of CRKP.Methods 54 hospitalized patients who were diagnosed with CRKP HAI in organ transplantation ward of a hospital from January 1,2014 to July 31,2018 were selected as the case group,and 27 hospitalized patients diagnosed with carbapenem-susceptible Klebsiella pneumoniae(CSKP)HAI during the same period were selected as the control group,retrospective case-control study was conducted.Results Infection sites of two groups of patients were mainly lower respiratory tract(42.59%and 48.15%)and surgical site(44.44%and 25.93%);except for cefazolin,resistance rates of Klebsiella pneumoniae to other 20 kinds of antimicrobial agents in two groups of patients were all statistically different(all P<0.05).Univariate analysis showed that patients’age,antimicrobial use≥3 type,carbapenem use,and antifungal use before specimen detection were all associated with CRKP HAI in patients after organ transplantation(all P<0.05);multivariate analysis showed that patients’age,antimicrobial use≥3 type,and carbapenem use before specimen detection were independent risk factors for CRKP HAI in patients after organ transplantation.Conclusion Prevention and control measures of HAI in patients after organ transplantation should be strengthened according to risk factors,especially the rational use of carbapenems.