某医院产碳青霉烯酶肺炎克雷伯菌的相关调查  

Risk Factors, Drug Resistance and Dissemination Patterns of Carbapenem-resistant Klebsiella pneumoniae in One Hospital

作　　者：邹霞[1] 邓林强[2] 陈益国[2] 陈会[2] 兰玉娟[3] 熊章华[2] 余理智[2] 

机构地区：[1]江西省人民医院普外二科,江西南昌330006 [2]江西省人民医院检验科,江西南昌330006 [3]江西省人民医院院感科,江西南昌330006

出　　处：《现代预防医学》2014年第16期3056-3058,共3页Modern Preventive Medicine

基　　金：江西省自然科学基金(题目:TLR2受体配基PAM3SCK4激活免疫系统对耐甲氧西林金黄色葡萄球菌攻击动物的保护性研究;项目号:20132BAB205049)

摘　　要：目的明确某医院产碳青霉烯酶肺炎克雷伯菌的耐药特性、传播机制及其感染的危险因素。方法收集2013年1-6月临床获得的耐碳青霉烯类抗生素肺炎克雷伯菌(CRKP)17株,并对感染患者的相关临床资料进行回顾性分析,同时对同期出现该病例较为集中的ICU病区进行相关环境监测。结果CRKP除对复方新诺明和四环素耐药率较低(为11.8%)外,对其他11种常用抗菌药物耐药率均达到90%以上;17株CRKP Hodge试验均阳性,而双纸片协同试验均阴性;13例ICU病区感染患者使用的呼吸机中分离获到了CRKP;17例病人中有16位气管插管并使用呼吸机辅助通气,其中1例患者行腹腔引流和深静脉置管。结论气管插管、借用呼吸机辅助通气和碳青霉烯类抗生素的使用是该院CRKP重要的传播途径和感染因素;CRKP耐药及多重耐药性严重,临床可选用的抗菌药有限,应根据药敏结果合理选用。Objective This study aimed to characterize risk factors, drug resistance and dissemination patterns of carbapenem-resistant Klebsiella pneumoniae isolated from clinical samples. Methods A total of 17 strains of carbapenem-resistant K. pneumonaie （CRKP） were isolated in one hospital from January 2013 to June 2013 and patients＇ clinical records were reviewed. Results Totally 17 CRKP strains were multidrug -resistant to β-lactams, aminoglycosides and quinolones, yet 88.2% isolates remained susceptible to SXT, TET according to current CLSI breakpoints. All 17 strains were positive in CRKP Hodge test and negative in double disk synergy test. CRKP were isolated from 13 Patients＇ ventilator in ICU ward. A total of 16 patients had tracheal intubation by ventilator and one of them received abdominal drainage and deep vein catheterization. Conclusion CRKP probably disseminates by contaminant ventilators, which indicates ventilators should be sterilized thoroughly before use. Patients infected by CRKP should be administered tetracyelines timely alone or treated in combination with other antibiotics according to antimicrobial sensitivity test.

关 键 词：碳青霉烯酶 肺炎克雷伯菌 医院感染 

分 类 号：R194[医药卫生—卫生事业管理]