耐碳青霉烯类肺炎克雷伯菌的感染特征和危险因素

Distribution and Risk Factors of Carbapenem-resistant Klebsiella Pneumoniae

目的了解耐碳青霉烯类肺炎克雷伯菌的感染特征和危险因素。方法选取某三级综合医院2018年1月—2020年12月检出肺炎克雷伯菌的所有住院患者作为研究对象,采用回顾性病例-对照研究方法,选取该时段内检出碳青霉烯类耐药肺炎克雷伯菌(carbapenem-resistant klebsiella pneumoniae,CRKP)的住院患者作为病例组,232株;选择同期检出碳青霉烯类敏感肺炎克雷伯菌(carbapenem susceptive klebsiella pneumoniae,CSKP)的住院患者作为对照组,829株,将单因素分析有意义的因素纳入Logistic回归模型进行多因素分析,研究CRKP感染的危险因素。结果单因素分析显示,患者年龄、基础疾病、肺部疾病、泌尿道感染、脓毒血症、高血压、住院时长、入住ICU史、入住ICU时长、抗菌药物的使用、种类及使用时长、呼吸机、尿道插管、中心静脉置管均与CRKP感染有关(P<0.05)。多因素分析结果显示,年龄≥65岁、ICU入住史、ICU入住天数≥5 d,使用抗菌药物>14 d、联用抗菌药物、有基础疾病、患泌尿道感染为CRKP感染独立危险因素。结论应加强对易感人群的监控,并采取积极措施预防CRKP感染,例如加强高龄患者的护理,尽量缩短在ICU的住院时间,积极正规治疗基础疾病,提升医务工作者侵入性操作的规范性,规范使用抗菌药物等。

Objective To investigate and understand the epidemiological characteristics and risk factors of carbapenemresis tant klebsiel la pneumoniae(CRKP).Methods A retrospective investigation method was used to collect data of klebsiella pneumoniae(KP)cases in a third-grade general hospital from January 2018 to December 2020.A total of 232 hospitalized patients infected with CRKP were selected as case group,while 829 infected with carbapenem susceptive klebsiella pneumoniae(CRKP)were as control group.Unconditional Logistic regression was used to find out independent risk factors of CRKP infections.Results According to univariate analysis,the factors associated with the development of CRKP infection were:age,underlying diseases including lung diseases,urinary tract infection,sepsis,hypertension,length of stay,ICU admission history,length of hospitalization in ICU,using of antibiotics before infection and using length,using 2 or more antibiotics before infection,using special antibiotics,ventilator,urethral catheterization and central venous catheterization(P<0.05).The unconditional Logistic multiple regression analysis revealed that age≥65,ICU admission history,length of hospitalization in ICU≥5 d,using of antibiotics before infection>14 d,using 2 or more antibiotics before infection,underlying diseases,urinary tract infection were all significantly independent risk factors for CRKP infection.Conclusion Measures should be taken to prevent infection of CRKP,such as:pay more attention on susceptible population,strengthen nursing care of elderly patients,minimize the length of stay in the ICU,pay enough attention to underlying diseases and give them appropriate treatments,standardize invasive operations and the use of antibiotics.