严重烧伤患者肺炎克雷伯菌所致血流感染危险因素及耐药情况的研究

Risk factors and drug resistance of blood stream infection caused by Klebsiella pneumoniae in severe burn patients

目的 探讨严重烧伤患者肺炎克雷伯菌所致血流感染危险因素及耐药情况。方法 选择郑州市第一人民医院烧伤科住院病房2017年10月至2021年10月收治严重烧伤患者为研究对象。113例符合纳排标准患者将通过连续血培养明确KP血流感染患者纳入感染组,将其余患者纳入非感染组。统计所有患者临床资料,包括性别、年龄、烧伤原因、烧伤总面积、Ⅲ度烧伤面积、合并吸入性损伤、机械通气、置管部位和导管留置时间。使用VITEK-2 Compact全自动微生物鉴定系统对检出KP耐药性进行鉴定。结果 感染组和非感染组性别、年龄、烧伤原因、机械通气、置管部位比较差异无统计学意义(P>0.05),两组烧伤总面积、合并吸入性损伤、Ⅲ度烧伤面积、导管留置时间比较差异具有统计学意义(P<0.05);多因素logistics回归分析结果显示烧伤总面积、合并吸入性损伤、Ⅲ度烧伤面积、导管留置时间均是导致严重烧伤患者发生KP所致BSI的独立影响因素(P<0.05);血培养检出KP对环丙沙星、头孢唑啉、哌拉西林/他唑巴坦钠耐药率均为100.00%,对阿米卡星(75.22%)、头孢哌酮舒巴坦钠(66.32%)、亚胺培南西司他丁针(60.87%)、美罗培南(60.87%)耐药率较高,对替加环素(4.35%)和多黏菌素B(0.00%)耐药率较低。结论 烧伤总面积、合并吸入性损伤、Ⅲ度烧伤面积和导管留置时间是导致严重烧伤患者发生肺炎克雷伯菌感染所致血流感染的影响因素,检出KP菌对多种抗菌药物均有较高耐药率,替加环素及多黏菌素耐药率较低,建议选用替加环素或多黏菌素类为基础的联合抗感染方案进行治疗。

Objective To investigate the risk factors and drug resistance of blood stream infection caused by Klebsiella pneumoniae in severe burn patients.Methods Severe burn patients admitted to the inpatient ward of the burn Department of our hospital from October 2017 to October 2021 were selected as subjects. 113 patients with KP bloodstream infection will be included in the infection group through continuous blood culture, and the remaining patients will be included in the non-infection group. Clinical data of all patients were collected, including gender, age, cause of burn, total burn area, third-degree burn area, inhalation injury, mechanical ventilation, catheter placement site and catheter indwelling time. The detected KP resistance was identified using vitEK-2 Compact automatic microbial identification system.Results There were no significant differences in gender, age, burn causes, mechanical ventilation and catheterization site between the infected group and the non-infected group(P>0.05), but there were significant differences in total burn area, combined inhalation injury, third-degree burn area and catheter indwelling time between the two groups(P<0.05). The results of multi-factor logistics regression analysis showed that total burn area, combined inhalation injury, third-degree burn area and catheter retention time were independent influencing factors of KP-induced BSI in severe burn patients(P<0.05). Blood culture showed that the drug resistance rates of KP to ciprofloxacin, cefazolin, piperacillin/tazobactam sodium were 100.00%, and the drug resistance rates to amikacin(75.22%), cefoperazone sulbactam sodium(66.32%), imipenem cilastatin needle(60.87%), meropenem(60.87%) were higher. The drug resistance rate to tigecycline(4.35%) and polymyxin B(0.00%) was low. Conclusion Total burn area, combined inhalation injury, third-degree burn area and catheter indwelling time are the influential factors leading to blood stream infection caused by Klebsiella pneumoniae infection in severe burn patients. KP bacteria were found to have high drug resistance rate to various antibacterial drugs. The drug resistance rates of tigecycline and polymyxin are low, so tigecycline or polymyxin based combined anti-infection regimen is recommended for treatment.