耐碳青霉烯类肺炎克雷伯菌感染的临床危险因素分析

Analysis of clinical risk factors of carbapenem resistant Klebsiellapneumoniae infection

目的探究发生耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的临床危险因素,有助于积极采取防控措施防止其感染的发生。方法回顾性分析我院发生肺炎克雷伯菌感染的319例患者的病例资料,根据感染菌株类型将患者分为CRKP感染组(78例)、碳青霉烯类药物敏感的肺炎克雷伯菌(CSKP)感染组(241例)。比较两组对抗菌药物的耐药情况,并分析CRKP感染的危险因素。结果两组对替加环素的耐药率无显著差异(P>0.05);CRKP感染组对除替加环素以外其他抗生素的耐药率高于CSKP感染组(P<0.05)。Logistic回归分析结果显示,APACHEⅡ评分≥20分、入住ICU时间≥5 d、有CRKP感染者接触史、连续使用抗菌药物≥1周、联合应用抗菌药物种类≥3种、分离菌株2周前使用碳青霉烯类抗菌药物、留置导尿管、呼吸道插管、机械通气均为CRKP感染的独立危险因素(P<0.05)。结论CRKP感染的危险因素主要在于抗菌药物的不合理应用、侵入性操作过多等方面,临床应针对上述因素采取积极有效的治疗措施,以降低医院感染发生的风险。

Objective To explore the clinical risk factors of carbapenem resistant Klebsiella pneumoniae(CRKP)infection,and to actively take preventive and control measures to prevent the occurrence of infection.Methods The case data of patients with Klebsiella pneumoniae infection in our hospital were retrospectively analyzed.According to the type of infection strains,the patients were divided into CRKP infection group(78 cases)and carbapenem sensitive Klebsiella pneumoniae(CSKP)infection group(241 cases).The antimicrobial resistance of the two groups was compared,and the risk factors of CRKP infection were analyzed.Results There was no significant difference in the resistance rate of tigecycline between the two groups(P>0.05);the resistance rates of the CRKP infection group to other antibiotics except pertigacycline were higher than those of the CSKP infection group(P<0.05).Logistic regression analysis result showed that APACHEⅡscore≥20 points,ICU stay≥5 d,contact history of CRKP infected patients,continuous use of antibiotics for more than 1 week,combined use of antibiotics for more than 3 kinds,use of carbapenems antibiotics before 2 weeks of isolating strains,indwelling catheter,respiratory intubation and mechanical ventilation were independent risk factors for CRKP infection(P<0.05).Conclusion The risk factors of CRKP infection mainly lie in the irrational use of antibiotics,excessive invasive operation and so on.In order to reduce the risk of nosocomial infection,active and effective treatment measures should be taken according to the above factors.