医院获得性肺炎克雷伯菌血流感染的临床特征及耐药菌株感染的危险因素分析  

Carbapenem-susceptible versus carbapenem-resistant Klebsiella pneumoniae bloodstream infection:Clinical manifestations and risk factors

作　　者：杨修文[1] 崔俊昌[1] 赵进[1] 倪文涛[1] 

机构地区：[1]解放军总医院呼吸科,北京100853

出　　处：《解放军医学院学报》2017年第11期1029-1032,1054,共5页Academic Journal of Chinese PLA Medical School

基　　金：国家自然科学基金项目(81371855)~~

摘　　要：目的了解肺炎克雷伯菌血流感染的临床特征,探讨碳青霉烯类耐药肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)血流感染的危险因素。方法回顾性分析2011年6月-2016年8月本院190例肺炎克雷伯菌血流感染患者的临床资料。根据是否对碳青霉烯类药物耐药分为碳青霉烯类耐药肺炎克雷伯菌血流感染组和碳青霉烯类敏感肺炎克雷伯菌(carbapenem-susceptive Klebsiella pneumoniae,CSKP)血流感染组,采用多因素Logistic回归方法分析碳青霉烯类耐药肺炎克雷伯菌血流感染的危险因素。结果本研究共纳入190例肺炎克雷伯菌血流感染患者,共检出CRKP 60例,耐药菌所占比例为31.6%(60/190)。多因素结果分析显示抗生素的暴露(OR=5.06,95%CI:2.15~11.93,P=0.000)、合并呼吸系统疾病(OR=3.99,95%CI:1.49~10.7,P=0.006)、接受侵入性治疗(OR=26.00,95%CI:2.88~234.98,P=0.004)为碳青霉烯类耐药肺炎克雷伯菌血流感染的独立危险因素。结论碳青霉烯类耐药肺炎克雷伯菌的检出率呈快速增高趋势,碳青霉烯类耐药肺炎克雷伯菌血流感染的发生与院内侵入性治疗及抗生素的暴露(特别是碳青霉烯类药物和β内酰胺类/酶抑制剂)等因素密切相关。Objective To study the clinical characteristics of K.pneumoniae bloodstream infection, and explore the risk factors for bloodstream infection caused by carbapenem-resistant K.pneumoniae（CRKP）. Methods Clinical data about 190 cases with K.pneumoniae bloodstream infection in Chinese PLA General Hospital from June 2011 to August 2016 were retrospectively analyzed. The patients were divided into two groups according to resistance to carbapenem, patients with CRKP bloodstream infection and those with carbapenem-susceptive K.pneumoniae（CSKP） bloodstream infection. The independent risk factors of CRKP bloodstream infection were identified by logistic regression analysis. Results There were 190 non-duplicated K.pneumoniae blood isolates identified in our research, with the overall proportion of carbapenem-resistant strains reaching 31.6% over the past five years. In logistic regression analysis, being exposed to antibiotics（OR=5.06, 95% CI： 2.15-11.93, P=0.000）, complicated with respiratory diseases（OR=3.99, 95% CI： 1.49-10.7, P=0.006） and receiving indwell invasive devices（OR=26.00, 95% CI： 2.88-234.98, P=0.004） were identified as independent risk factors for CRKP bloodstream infection. Conclusion Carbapenem-resistant K.pneumoniae is an emerging multi-drug resistant nosocomial pathogen. Indwelling invasive devices in hospital and being exposed to antibiotics, especially carbapenem and beta-lactam/lactamase inhibitors, are associated with the produce of carbapenem-resistant strains.

关 键 词：碳青霉烯类耐药 肺炎克雷伯菌 血流感染 危险因素 

分 类 号：R378.996[医药卫生—病原生物学]