耐碳青霉烯类肺炎克雷伯菌感染的临床特征及耐药机制研究

Study on the Clinical Characteristics of Carbapenem-Resistant Klebsiella Pneumoniae Infection and Its Resistance Mechanisms

目的调查耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CR-KP)感染的临床特征及耐药机制,并分析感染CR-KP高毒力株(carbpenem-resistant hypervirulent Klebsiella pneumoniae,CR-hvKP)的危险因素。方法收集2016年1月~2020年12月从德阳市人民医院住院患者送检标本中分离的CR-KP,分析CR-KP检出变化趋势,比较CR-KP在不同科室及不同标本类型的分布情况,检测CR-KP对常用抗生素的耐药性及碳青霉烯酶基因携带情况;收集CR-KP感染患者的临床资料,比较高毒力株感染组(CR-hvKP组)和非高毒力株感染组(CR-cKP组)的危险因素。结果总计分离出89株CR-KP,在肺炎克雷伯菌中占比3.47%(89/2562),总体上呈逐年上升趋势。CR-KP主要来源于ICU 16株(17.98%)、感染科13株(14.61%)和肿瘤科13株(14.61%);标本类型主要为痰液45株(50.56%)、尿液14株(15.73%)和脓液11株(12.36%)。CR-KP对大部分常用抗生素耐药,但对头孢他啶-阿维巴坦和黏菌素耐药率较低。CR-KP碳青霉烯酶基因检出率为78.65%(70/89),主要为bla_(KPC),bla_(NDM)。年龄≥60岁、糖尿病、肝胆疾病、机械通气、留置导管和入住ICU共6个因素,在CR-hvKP组和CR-cKP组之间的差异均有统计学意义(χ^(2)或Fisher=4.973~19.377,均P<0.05)。经多因素logistic回归分析,糖尿病(OR=10.947,95%CI:1.751~68.424,P=0.010)、入住ICU(OR=16.012,95%CI:2.589~99.036,P=0.003)是CR-hvKP感染的独立危险因素。结论该院CR-KP检出总体上呈逐年上升趋势,携带bla_(KPC),bla_(NDM)是CR-KP的主要耐药机制,糖尿病、入住ICU是CR-hvKP感染的重要危险因素。

Objective To investigate the clinical characteristics and resistance mechanisms of Carbapenem-resistant Klebsiella pneumoniae(CR-KP)infection,and analyze the risk factors of carbpenem-resistant hypervirulent Klebsiella pneumoniae(CR-hvKP)infection.Methods CR-KP isolated from the specimens submitted by inpatients in Deyang People’s Hospital from January 2016 to December 2020 were collected,and the trend of CR-KP detection rate were analyzed.The distribution of CR-KP in different departments and different specimen types were compared.At the same time,the resistance of CR-KP to common antibiotics and the carbapenem genes carryed by CR-KP were detected.The clinical data of patients with CR-KP infection were collected to compare the risk factors between carbpenem-resistant hypervirulent Klebsiella pneumoniae infection group(CR-hvKP group)and carbapenem-resistant classic Klebsiella pneumoniae(CR-cKP group).Results A total of 89 strains of CR-KP were isolated,accounting for 3.47%(89/2562)of Klebsiella pneumoniae,and the detection rate of CR-KP generally increased year by year.CR-KP mainly included 16 strains in ICU(17.98%),13 strains in Infection Diseases Department(14.61%),and 13 strains in Oncology Department(14.61%).The main types of specimens were 45 strains in sputum(50.56%),14 strains in urine(15.73%),and 11 strains in pus(12.36%).CR-KP was resistant to most common antibiotics,but the resistance rate to ceftazidime-avibatan or colistin was low.The detection rate of carbapenemase genes in CR-KP was 78.65%(70/89),mainly bla_(KPC) and bla_(NDM).There were six factors including age≥60 years old,diabetes mellitus,hepatobiliary disease,mechanical ventilation,indwelling catheter and admission to ICU,which were statistically different between CR-hvKP group and CR-cKP group(χ^(2)or Fisher=4.973~19.377,all P<0.05).Multivariate logistic regression analysis showed that diabetes mellitus(OR=10.947,95%CI:1.751~68.424,P=0.010)and admission to ICU(OR=16.012,95%CI:2.589~99.036,P=0.003)were independent risk factors for CR-hvKP infection.Conclusion The detection of CR-KP in the hospital was generally increasing year by year.Carrying bla_(KPC) or bla_(NDM) is the main resistance mechanisms of CR-KP.Diabetes mellitus and admission to ICU were important risk factors for CR-hvKP infection.