耐三代头孢肺炎克雷伯菌感染者血流感染的流行病学及危险因素分析(2015—2019年)

Epidemiology and risk factors of patients with the third generation cephalosporin resistant Klebsiella pneumoniae bloodstream infections(2015-2019)

目的了解耐三代头孢肺炎克雷伯菌(3GCR-Kp)血流感染的流行病学特征及其感染的危险因素,为预防和治疗该类菌的感染提供依据。方法收集重庆市大足区人民医院2015—2019年血流感染肺炎克雷伯菌患者的病例资料,根据是否对三代头孢(头孢曲松或头孢他啶)耐药分为耐药组(56例)和敏感组(102例),并选取与敏感组等比例的未发生血流感染的患者为对照组(102例),使用Vitek-2测定菌株药敏,PCR检测超广谱β内酰胺酶(ESBLs)相关基因,统计患者相关病例资料并采用病例-病例-对照的方式进行危险因素调查。结果血流感染中共检出158株肺炎克雷伯菌,其中3GCR-Kp(耐药组)56株,占35.4%,对三代头孢敏感肺炎克雷伯菌(敏感组)102株。检出菌最常见于肝胆外科(37株,23.4%)。耐药组细菌对氨曲南和环丙沙星耐药率较高为73.2%和64.3%。PCR结果显示,51株产ESBLs的肺炎克雷伯菌携带bla_(CTX-M)最多,共31株(60.8%)。Logistic回归分析结果显示,耐药组与敏感组相比,转院(OR=3.17,95%CI=1.26~7.94)、内分泌系统疾病(OR=2.44,95%CI=1.08~5.49)、感染前手术史(OR=2.88,95%CI=1.22~6.81)和头孢菌素类抗菌药物使用(OR=3.48,95%CI=1.52~7.93)是3GCR-Kp血流感染发生的独立危险因素。耐药组与对照组相比,肝胆疾病(OR=3.40,95%CI=1.28~9.00)、腹腔内感染(OR=4.73,95%CI=1.49~14.99)、感染前手术史(OR=2.55,95%CI=1.06~6.15)和头孢菌素类抗菌药物使用(OR=3.00,95%CI=1.32~6.82)是3GCR-Kp血流感染发生的独立危险因素。结论肺炎克雷伯菌血流感染中3GCR-Kp检出率较高;产ESBLs的肺炎克雷伯菌携带bla_(CTX-M)最多。感染前手术史和头孢菌素类抗菌药物使用是3GCR-Kp血流感染发生的共同独立危险因素。

Objectives To investigate the epidemiological characteristics and risk factors of the third generation cephalosporin resistant Klebsiella pneumoniae(3GCR-Kp)bloodstream infections,so as to provide theoretical evidence for prevention and treatment of the infection.Methods The clinical data of patients confirmed bloodstream infection with Klebsiella pneumoniae in People’s Hospital of Dazu County from 2015 to 2019 were retrospectively collected and divided into resistant group(56 cases)and sensitive group(102 cases)according to the drug susceptibility of the third generation cephalosporin(ceftriaxone or ceftazidim).And the patients without bloodstream infections in equal proportion were selected as the control group(102 cases).The drug susceptibility was determined by Vitek-2,and extended-spectrum β-lactamase(ESBLs)-related genes were detected by polymerase chain reaction(PCR).Clinical data of the inpatient were analyzed and risk factors were investigated by case-case-control method.Results A total of 158 Klebsiella pneumoniae strains were detected in the patients with bloodstream infections,which included 56 strains of 3GCR-Kp(resistant group,35.4%)and 102 strains of third-generation cephalosporin sensitive Klebsiella pneumoniae(sensitive group).The Klebsiella pneumoniae strains were commonly detected from department of hepatobiliary surgery(37 strains,23.4%).The resistance rates of the resistant group to aztreonam and ciprofloxacin were high(73.2% and 64.3%).PCR results showed that 31(60.8%)of 51 strains of ESBLs-producing Klebsiella pneumoniae carried bla_(CTX-M).Logistic regression analysis showed that hospital transfer(OR=3.17,95%CI=1.26-7.94),endocrine system diseases(OR=2.44,95%CI=1.08-5.49),history of surgery before infection(OR=2.88,95%CI=1.22-6.81)and cephalosporin use(OR=3.48,95%CI=1.52-7.93)were independent risk factors for resistant group compared to sensitive group;hepatobiliary disease(OR=3.40,95%CI=1.28-9.00),intraperitoneal infection(OR=4.73,95%CI=1.49-14.99),history of surgery before infection(OR=2.55,95%CI=1.06-6.15)and cephalosporin use(OR=3.00,95%CI=1.32-6.82)were independent risk factors for resistant group compared to control group.Conclusions The incidence of 3GCR-Kp in bloodstream infection is high.ESBLs-producing Klebsiella pneumoniae commonly carries bla_(CTX-M).History of surgery before infection and cephalosporin use are the common independent risk factors for 3GCR-Kp bloodstream infection.