院内获得耐碳青霉烯类抗菌药物肺炎克雷伯菌感染的危险因素分析  

Risk factors for nosocomial infections with carbapenem-resistant Klebsiella pneumoniae

作　　者：马红映[1] 汪丽[2] 虞亦鸣[3] 吕婉飞[2] 丁群力[3] 吕丹[3] 邓在春[3] 王翎[1] MA Hong-ying WANG Li YU Yi-ming LV Wan-fei DING Qun-li LV Dan DENG Zai-chun WANG Ling(The First Affiliated Hospitalof Suzhou University, Suzhou, Jiangsu 215006, China)

机构地区：[1]苏州大学附属第一医院老年医学科,江苏苏州215006 [2]宁波大学医学院附属医院微生物实验室,浙江宁波315020 [3]宁波大学医学院附属医院呼吸内科,浙江宁波315020

出　　处：《中华医院感染学杂志》2017年第7期1456-1458,共3页Chinese Journal of Nosocomiology

基　　金：宁波市自然科学基金资助项目(2016A610132);宁波市医学科技基金项目(2011B13)

摘　　要：目的了解医院临床分离的耐碳青霉烯类抗菌药物肺炎克雷伯菌(CRKP)所致医院获得性感染的危险因素,为临床治疗提供参考依据。方法选择2013-2015年入住医院CRKP感染患者60例为CRKP组,以分离病区及分离时间1∶1配对选取碳青霉烯类敏感的肺炎克雷伯菌(CSKP)医院感染患者60例为CSKP组,进行回顾性病例对照研究,数据采用SPSS 20.0软件进行统计分析。结果单因素分析显示,住院时间≥14d、抗菌药物暴露的时间≥14d、暴露抗菌药物的种类≥2种、暴露于碳青霉烯类抗菌药物、暴露于糖肽类抗菌药物、使用抗真菌药物、合并其他细菌≥2种、分离到真菌、前期CRKP的定植均与CRKP感染显著相关(P<0.05);CRKP所致医院感染的独立危险因素是暴露于碳青霉烯类抗菌药物(P<0.05)。结论 CRKP所致医院感染与多项危险因素相关,暴露于碳青霉烯类抗菌药物是其独立危险因素。OBJECTIVE To investigate the risk factors for nosocomial infections with carbapenem-resistant Kleb- siella pneumoniae （CRKP）, so as to provide references for clinical treatment. METHODS Sixty patients with nos- ocomially acquired CRKP infections between Jan. 2013 and Dec. 2015 were selected as CRKP group, and 60 cases of patients were selected at a ratio of 1 ： 1 from patients with nosocomial carbapenem-susceptible Klebsiella pneu- moniae （CSKP） infection and were matched with CRKP cases for sites of infections and the date of isolation, and were set as CSKP group. Retrospective case-control study was conducted, and the data were analyzed by SPSS 20. 0 software. RESULTS Univariate analysis showed that days of hospital stay≥14, days exposure to antibiotics 14, number of antibiotics kinds prior to isolation of KP≥2, exposure to earbapenems, exposure to glycopeptides, use of antifungal agents, number of coexisted bacteria ≥2, coexisted with fungi and KP colonization prior to KP infection were significantly correlated to CRKP infection （P〈0.05）. Exposure to earbapenems was the independ- ent risk factor for nosoeomial CRKP infections （P〈0.05）. CONCLUSION Several factors are related to nosocomi- al CRKP infections, and exposure to carbapenems is the independent risk factor.

关 键 词：肺炎克雷伯菌 碳青霉烯类耐药 病例对照研究 危险因素 

分 类 号：R378.996[医药卫生—病原生物学]