我院住院患者耐碳青霉烯肺炎克雷伯菌感染的回顾性分析

Retrospective Analysis of Carbapenem-resistant Klebsiella Pneumoniae Infection in Hospitalized Patients in Our Hospital

目的:分析我院2019年耐碳青霉烯肺炎克雷伯菌(CRKP)感染/定植情况,为临床治疗提供参考。方法:采用回顾性分析方法,查阅电子病历和临床微生物检测报告,对我院2019年1~12月耐碳青霉烯肺炎克雷伯菌感染患者的临床分布特征、易感因素及抗菌药物治疗效果进行统计分析。结果:纳入研究的59例CRKP感染患者主要分布在呼吸与危重症医学科(29例,49.2%)、肝胆外科(8例,13.5%)和重症医学科(8例,13.5%);CRKP易感因素包括住院时间长、抗菌药物的使用、基础疾病重、实体肿瘤、侵入性操作和低蛋白血症;59例CRKP感染患者参照专家共识推荐意见,采用碳青霉烯+喹诺酮类或替加环素+碳青霉烯类/头孢他啶阿维巴坦联合用药,取得较好的治疗效果(总有效率77.97%)。结论:了解CRKP的临床分布特征及感染危险因素,可以从源头上控制和预防CRKP的感染,遏制其进一步传播;根据专家共识对CRKP感染进行治疗,有效率较高。

Objective: To analyze the infection/colonization of carbapenem-resistant Klebsiella pneumoniae(CRKP) in our hospital from January to December in 2019 to provide reference for clinical treatment. Methods: Retrospective analysis was performed by checking electronic medical records and clinical microbiological test reports to analyze the clinical distribution characteristics,susceptibility factors and antimicrobial therapy efficacy of patients with CRKP infection in our hospital from January to December in 2019. Results: The 59 patients with CRKP infection were mainly distributed in respiratory and critical care department(29 cases,49.2%),hepatobiliary surgery(8 cases,13.5%) and intensive care unit(8 cases,13.5%). The risk factors of CRKP included old age,long hospital stay,antibiotic use,severe underlying disease,solid tumors,invasive procedures and hypoproteinemia. Totally 59 CRKP infection patients were treated with carbapenems+quinolones or tigecycline+carbapenem/ceftazidine according to the laboratory diagnosis,clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli: a Chinese Consensus Statement,and promising treatment effect with the total effective rate of 77.97% was achieved. Conclusion: Understanding the clinical distribution characteristics and infection risk factors of CRKP can control and prevent the infection of CRKP from the source and prevent its further spread. Treatment of CRKP infection according to expert consensus can achieve a high effective rate.