神经内科住院患者耐碳青霉烯类肺炎克雷伯菌耐药基因分布及预后影响因素

Distribution of drug resistance genes of carbapenem-resistant Klebsiella pneumoniae in inpatients of neurology department and influencing factors of prognosis

目的分析神经内科住院患者耐碳青霉烯类肺炎克雷伯菌(CRKP)耐药基因及预后影响因素。方法2017年6月-2020年6月扬州大学附属医院收治的80例神经内科住院患者为研究对象,分离CRKP菌株共86株,采用聚合酶链式扩增反应(PCR)法对CRKP菌株KPC、OXA-48、IMP、NDM、SHV耐药基因进行扩增。通过电子病历系统调取患者病史资料及实验室检查结果,包括年龄、性别、感染前住院时间、感染前手术史、合并糖尿病、合并肾功能不全、急性生理与慢性健康评分(APACHEⅡ)、预后营养指数(PNI)评分、留置导尿管、二次气管插管情况,根据临床资料分析患者预后不良影响因素。结果86株CRKP感染患者药敏试验结果显示,检出CRKP菌株对厄他培南、亚胺培南、头孢曲松、美罗培南、头孢噻肟、磺胺甲噁唑/甲氧苄啶、头孢他啶、左氧氟沙星和环丙沙星耐药率均超过80%,对替加环素、多黏菌素耐药率较低;86株CRKP菌株73株检出耐药基因,其中59株检出1种耐药基因,14株检出2种耐药基因,各耐药基因中KPC(66.28%)检出率最高;对两组患者临床资料分析结果显示,神经内科CRKP感染患者预后不良与年龄、APACHEⅡ评分、PNI评分有关(P<0.05);Logistic回归分析结果显示APACHEⅡ评分是CRKP患者预后不良的影响因素(P<0.05)。结论医院神经内科CRKP检出情况较为严峻,CRKP对替加环素、多黏菌素耐药率较低,临床可据此针对性的治疗,而APACHEⅡ评分高是神经内科CRKP感染患者预后不良的危险因素,对于此类患者应加强针对性干预,最大限度改善其预后。

OBJECTIVE To analyze the drug resistance gene of carbapenem-resistant Klebsiella pneumoniae(CRKP)and its prognostic factors in inpatients of neurology department.METHODS Total of 80 inpatients admitted to the department of neurology in the Affiliated Hospital of Yangzhou University from Jun 2017 to Jun 2020 were recruited.Eighty-six CRKP strains were isolated.The drug resistance genes of KPC,OXA-48,IMP,NDM and SHV were amplified by polymerase chain reaction(PCR).The medical history data and laboratory examination results of patients were collected by electronic medical record system,including age,gender,length of hospital stay before infection,history of surgery before infection,diabetes mellitus,renal insufficiency,the scores of acute physiology and chronic health evaluation II(APACHEⅡ),prognostic nutritional index(PNI),indwelling catheter and secondary tracheal intubation.The adverse factors for prognosis were analyzed according to clinical data.RESULTS The drug sensitivity test showed that drug resistance rates of 86 strains to ertapenem,imipenem,ceftriaxone,meropenem,cefotaxime,compound sulfamethoxazole,ceftazidime,levofloxacin and ciprofloxacin were more than 80%,and those to tigecycline and polymyxin were lower.Among the 86 CRKP strains,drug-resistant genes were detected in 73 strains,of which one resistant gene was detected in 59 strains and 2 types of resistant genes were detected in 14 strains.The resistant genes of KPC had the highest detection rate(66.28%).The clinical data analysis showed that the poor prognosis of patients with CRKP infection in the neurology department was related to age,APACHEⅡscore and PNI score(P<0.05).Multivariate Logistic regression analysis showed that APACHEⅡscore was independent risk factors for poor prognosis of CRKP patients(P 0.05).CONCLUSION The detection rate of CRKP in the neurology department of our hospital was relatively severe.Based on the low drug-resistant rate of CRKP to tegacyclin and polymyxin,clinical treatment could be rationally performed.High score of APACHEⅡwas a risk for poor prognosis in patients with CRKP infection in the neurology department,and targeted intervention should be strengthened for such patients to maximize their prognosis.