耐碳青霉烯类肺炎克雷伯菌医院感染及定植危险因素

Risk factors for carbapenem-resistant Klebsiella pneumoniae healthcare-associated infection and colonization

目的 了解耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染及定植的危险因素。方法 选择北京大学第一医院2020年1月1日—12月31日所有检出肺炎克雷伯菌的住院患者为研究对象,通过回顾性调查明确感染基本情况。采取病例对照研究,将CRKP医院感染和定植患者作为病例组,共59例;碳青霉烯类敏感肺炎克雷伯菌(CSKP)医院感染和定植患者作为对照组,共79例。调查CRKP医院感染及定植的危险因素。结果 感染基本情况:2020年1-12月共86例患者不同部位检出105株CRKP,其中社区感染31株(26例),社区定植1株,医院感染51株(46例),医院定植22株(21例)。CRKP医院感染率为0.11例/千住院日,医院定植率为0.35‰。单因素分析:年龄≥65岁、男性、呼吸衰竭、急诊入院、急诊滞留≥48 h、入院前使用碳青霉烯类药物、入院前存在感染、住院期间使用呼吸机+人工气道、留置尿管、住院时长、入住重症监护室(ICU)、使用碳青霉烯类、头孢菌素类(>7 d)、四环素类、氟喹诺酮类、糖肽类抗菌药物以及联合用药可使发生CRKP医院感染/定植风险增加(P<0.05)。多因素分析:年龄≥65岁、入院前存在感染、使用碳青霉烯类抗菌药物是发生CRKP医院感染/定植的危险因素(P<0.05)。结论 CRKP医院感染及定植的防控需关注高发部位、急诊患者及碳青霉烯类抗菌药物的管理。

OBJECTIVE To understand the risk factors for carbapenem-resistant Klebsiella pneumoniae(CRKP) healthcare-associated infection(HAI) and colonization. METHODS From Jan 1, 2020 to Dec 31, 2020, the hospitalized patients who were detected with K.pneumoniae in Peking University were recruited as the study subjects, a retrospective survey was conducted to understand the basic information of the infection. By means of case-control study, totally 59 patients with CRKP HAI and colonization were assigned as the case group, and 79 patients with carbapenem-sensitive K.pneumoniae HAI and colonization were assigned as the control group. The risk factors for the CRKP HAI and colonization were investigated. RESULTS A total of 105 strains of CRKP were isolated from the sites of 86 patients between Jan 2020 and Dec 2020, including 31 strains isolated from 26 cases of community-acquired infection, 1 strain of colonization, 51 strains isolated from 46 cases of HAI, and 22 strains isolated from 21 cases of nosocomial colonization. The incidence rate of CRKP HAI was 0.11 case/1000 hospitalization days, the colonization rate was 0.35‰. Univariate analysis showed that the no less than 65 years of age, male, respiratory failure, hospitalization for emergency treatment, emergency detention time no less than 48 hours, use of carbapenems before the admission, infection before the admission, use of ventilator plus artificial airway during hospital stay, urinary catheter indwelling, long length of hospital stay, intensive care unit(ICU) stay, use of carbapenems, cephalosporins(more than 7 days), tetracyclines, quinolones, glycopeptides and combined use of antibiotics could increase the risk of CRKP HAI or colonization(P<0.05). Multivariate analysis indicated that the no less than 65 years of age, infection before the admission and use of carbapenems were the risk factors for the CRKP HAI or colonization(P<0.05). CONCLUSION It is necessary to focus on the highly prevalent sites of infection, emergency treatment patients and management of carbapenems so as to prevent and control the CRKP HAI and colonization.