耐碳青霉烯类肺炎克雷伯菌感染患者临床分布特点、耐药基因及相关危险因素分析

Analysis of Clinical Distribution Characteristics,Drug Resistance Genes,and Related Risk Factors of Patients with Carbapenem-Resistant Klebsiella Pneumoniae Infection

目的探析耐碳青霉烯类肺炎克雷伯菌(CRKP)感染患者分布特点、耐药基因以及相关危险因素,以避免抗菌药物的不合理使用。方法回顾性分析2017年1月至2021年9月确诊的619例肺炎克雷伯菌(KPN)感染患者的临床资料,对CRKP感染分布特点及耐药基因进行统计分析,采用单因素、多因素logistic回归分析CRKP感染发生的危险因素。结果619例中,51例(8.24%)为CRKP,568例(91.76%)为碳青霉烯类敏感肺炎克雷伯菌(CSKP)。与CSKP组相比,CRKP组医院获得性感染、科室分布为神经内科以及1个月内使用过碳青霉烯类药物的占比更高,科室分布为呼吸科的占比更低,且CRKP组对多磷酸类、中效磺胺类、氨基苷类、碳青霉烯类、头孢菌素类、青霉素类、喹诺酮类抗菌药物的耐药率更高(P<0.05,P<0.01)。PCR扩增耐药基因显示,51株CRKP菌种中30株(58.9%)携带bla_(KPC-2)基因,18株(35.3%)携带bla_(NDM)基因,2株(3.9%)携带bla_(IMP)基因,1株(1.9%)携带bla_(OXA-48)基因,2株(3.9%)同时携带bla_(KPC-2)和bla_(NDM)基因。多因素logistic回归分析显示,血清白蛋白<35 g/L、急性生理功能和慢性健康状况评分系统Ⅱ评分≥20分、有留置管、机械通气≥7 d、1个月内使用过碳青霉烯类药物、使用≥3种抗菌药物、住院时间≥20 d、携带多种耐药菌是CRKP感染的独立危险因素(P<0.05,P<0.01)。结论CRKP在医院获得性感染中占比较高,检测CRKP耐药情况及耐药基因可指导临床合理选择抗菌药物,从而减少耐药的发生,防控CRKP感染。

Objective To investigate the distribution characteristics,drug resistance genes and related risk factors of carbapenem-resistant Klebsiella pneumoniae(CRKP)infection,so as to avoid the unreasonable use of antibiotics.Methods The clinical data of 619 patients diagnosed with Klebsiella pneumoniae(KPN)infection from January 2017 to September 2021 were retrospectively analyzed.The distribution characteristics of CRKP infection and drug resistance genes were statistically analyzed,and the risk factors of CRKP infection were analyzed by univariate and multivariate Logistic regression.Results Of the 619 patients,51(8.24%)had CRKP and 568(91.76%)had carbapenem-sensitive Klebsiella pneumoniae(CSKP).Compared with CSKP group,the proportion of nosocomial infection,bacteria distribution in neurology department and carbapenems used within 1 month in CRKP group was higher,while the proportion of bacteria distribution in respiratory department was lower.In addition,the drug resistance rate of the CRKP group to polyphosphate,intermediate-acting sulfonamides,aminoglycosides,carbapenems,cephalosporins,penicillins and Quinolone antibiotics was higher(P<0.05,P<0.01).PCR amplification of drug resistance genes showed that 30(58.9%)of 51 CRKP strains carried bla_(KPC-2) gene,18(35.3%)carried bla_(NDM) gene,2(3.9%)carried bla_(IMP) gene and 1(1.9%)carried bla_(OXA-48) gene.Two other strains(3.9%)carried both bla_(KPC-2) and bla_(NDM) genes.Multivariate logistic regression analysis showed that serum albumin<35 g/L,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score≥20,duration of indwelling catheter and mechanical ventilation≥7 d,use of carbapenems within 1 month,use of≥3 antibiotics,length of hospital stay≥20 d,and carrying multiple drug-resistant bacteria were independent risk factors for CRKP infection(P<0.05,P<0.01).Conclusion CRKP accounts for a relatively high proportion of nosocomial infections,and detecting CRKP resistance and resistance genes can guide the rational selection of antibiotics in clinical practice,thereby reducing the occurrence of resistance and preventing CRKP infection.