碳青霉烯类耐药肺炎克雷伯菌感染39例  

Clinical analysis of 39 patients with carbapenem-resistant Klebsiella pneumoniae infection

作　　者：吴丹丹[1] 蔡加昌[2] 刘进[1] 

机构地区：[1]浙江大学医学院附属第二医院感染性疾病科,杭州310009 [2]浙江大学医学院附属第二医院检验科细菌室,杭州310009

出　　处：《中华传染病杂志》2010年第12期743-747,共5页Chinese Journal of Infectious Diseases

摘　　要：目的 探讨碳青霉烯类耐药肺炎克雷伯菌（carbapenem-resistant Klebsiella pneumoniae,CRKP）感染的临床特点、易感因素及防治措施.方法 对2006年7月至2008年7月在浙江大学医学院附属第二医院不同病区住院期间分离和培养到CRKP且临床证实为医院感染的39例患者进行回顾性调查分析.结果 39份CRKP阳性标本中,痰标本22份,占56.4%,CRKP感染者平均年龄为64.0岁,平均住院时间达80.8 d,36例2周内曾入住ICU,其中以脑科ICU比例最高,意识障碍者26例,38例留置导尿,34例留置中心静脉导管,32例行机械通气,30例行气管插管,27例（69.2%）合并其他细菌感染,8例合并真菌感染.病情恶化及死亡18例,占46.2%.在培养到CRKP前,27例（69.2%）患者更换超过4种抗菌药物,使用最多的为β-内酰胺酶抑制剂合剂和碳青霉烯类抗菌药物.结论 CRKP感染多发生在老年及长时间住院的患者中,以ICU患者居多,各种侵入性操作可增加其感染概率.Objective To investigate the clinical characteristics, risk factors and prevention measures of carbapenem-resistant Klebsiella pneumoniae （CRKP） infection. Methods Thirty-nine cases whose CRKP isolation and culture were positive and who were confirmed with nosocomial infection in 2nd affiliated hospital medical school of Zhcjiang University between July 2006 and July 2008 were retrospectively investigated. Results There were 22 （56.4%） sputum specimens among CRKP samples. The average age of the patients was 64.0 years old and the average length of staying in hospital was 80.8 days. There wcre 36 patients who had been in intensive care unit （ICU） within 2 weeks and 26 were conscious disturbance,38 received urethral catheterization, 34 inserted with central venous catheter, 32 received tracheal intubation and 30 assisted with mechanical ventilation. There were 27 （69. 2 % ） patients who were co-infected with other bacteria and 8 were co-infccted with fungi. The mortality was 46. 2% in patients with CRKP infection. Before CRKP-positive culture, 27 （69.2%）experienced 〉4 kinds of antibiotics with the majority of β-lactams/β-lactamase inhibitors and carbapenems.Conclusions CRKP infection frequently occurrs in elder and patients who prolonged stay in hospital,especially patients in ICU. Invasive procedures could increase the infection opportunities.

关 键 词：克雷伯菌 肺炎 Β内酰胺酶类 青霉素抗药性 克雷伯菌感染 死亡率 

分 类 号：R686[医药卫生—骨科学]