耐碳青霉烯类肺炎克雷伯菌的耐药性及预后相关因素分析  

Drug resistance and prognosis factors of carbapenem-resistant Klebsieila pneumonia

作　　者：钟秀君[1] 汤杰[1] 顾克菊[2] 孙晔佳 

机构地区：[1]上海中医药大学岳阳中西医结合医院呼吸科,上海200437 [2]上海中医药大学岳阳中西医结合医院医院感染管理科,上海200437

出　　处：《中华医院感染学杂志》2017年第6期1201-1205,共5页Chinese Journal of Nosocomiology

摘　　要：目的分析患者呼吸道感染耐碳青霉烯类肺炎克雷伯菌(CRKP)临床特征,探讨呼吸道感染CRKP患者预后的相关因素。方法收集2013年1月-2016年8月住院患者临床分离呼吸道标本耐碳青霉烯类肺炎克雷伯菌株数据,并用WHONET软件进行耐药性分析,采用单因素分析、多因素logistic回归分析方法对CRKP患者的临床资料进行回顾分析。结果 745株非重复分离的呼吸道肺炎克雷伯菌中,检出耐碳青霉烯类肺炎克雷伯菌98株,检出率13.15%,2013-2015年对碳青霉烯类耐药率分别为0.95%、7.34%、22.99%,呈逐年上升趋势,差异有统计学意义(P<0.01);CRKP检出率较高的前3位科室为ICU、急诊病房和老年病科;CRKP对阿米卡星和磺胺甲噁唑/甲氧苄啶的敏感率高,分别为62.24%、46.94%;98例患者死亡29例,病死率29.59%,单因素分析结果显示,患者慢性肺病(P<0.05)、总住院时间(P<0.05)及使用机械通气(P<0.05)、留置导尿(P<0.05)、中心静脉置管(P<0.05)、喹诺酮类(P<0.05)、糖肽类(P<0.05)、抗真菌类(P<0.05)药与CRKP患者死亡风险相关,多因素回归分析结果显示,慢性肺病(P<0.05)、留置导尿(P<0.05)、糖肽类(P<0.05)抗菌药物的使用与患者病死率密切相关。结论患者呼吸道耐碳青霉烯类肺炎克雷伯杆菌感染的比例有逐年升高趋势;慢性肺病、留置导尿、糖肽类抗菌药物使用是死亡的独立危险因素。OBJECTIVE To analyze the clinical features of carbapenem-resistant Klebsiella pneumonia（CRKP）of respiratory tract infection,and explore the prognostic factors of CRKP patients with respiratory tract infection.METHODS From Jan.2013 to Aug.2016,the clinical isolates of respiratory specimens from CRKP patients were collected and analyzed.The drug resistance was analyzed with WHONET software.The clinical data of CRKP patients were analyzed by univariate analysis and multivariate Logistic regression analysis.RESULTS There were 98 strains of CRKP detected from 745 strains of non repetitive respiratory tract infection isolates of K.pneumonia,with detection rate of 13.15%.From 2013 to 2015,the resistant rates to carbapenem were 0.95%,7.34% and22.99%,which was increased year by year,and the difference was significant（P〈0.01）.The top three departments of CRKP detection rate were ICU,the emergency ward and department of geriatrics.The sensitive rates of CRKP to amikacin and sulfamethoxazole/trimethoprim were high,which were respectively 62.24% and46.94%.There were 29 cases died in 98 cases,with the mortality rate of 29.59%.Univariate analysis showed that patients with chronic obstructive pulmonary disease（P〈0.05）,total hospitalization time（P〈0.05）and mechanical ventilation（P〈0.05）,catheterization（P〈0.05）,central venous catheter（P〈0.05）,quinolones（P〈0.05）,glycopeptide（P〈0.05）,and anti fungal drugs（P〈0.05）were related to the risk of death in patients with CRKP.multivariate regression analysis showed that chronic obstructive pulmonary disease（P〈0.05）,catheterization（P〈0.05）,and glycopeptide（P〈0.05）were closely related to the mortality rate of patients.CONCLUSION CRKP of respiratory tract infection rate increased year by year.The chronic obstructive pulmonary disease,use of indwelling catheter,and use of glycopeptide antibiotics are independent risk factors for death.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 耐药 预后 相关因素 

分 类 号：R378.996[医药卫生—病原生物学]