心胸外科术后继发耐碳青霉烯类肺炎克雷伯菌的临床观察及经验分享  

Clinical observation and experience sharing of carbapenem-resistant Klebsiella pneumoniae after cardiothoracic surgery

作　　者：江雪艳 杨琦 袁源 梅举 沈峰 JIANG Xue-yan;YANG Qi;YUAN Yuan;MEI Ju;SHEN Feng(Department of Cardiothoracic Surgery,Shanghai 200092,China;Department of Clinical Laboratory,Xinhua Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200092,China)

机构地区：[1]上海交通大学附属新华医院心胸外科监护室,上海市200092 [2]上海交通大学附属新华医院检验科,上海市200092

出　　处：《中国心血管病研究》2020年第7期635-638,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨心胸外科术后继发院内耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)感染的临床特点及治疗效果,为临床合理选用抗菌药物提供依据.方法回顾分析上海交通大学附属新华医院心胸外科监护室2018年6月至2019年1月发生的13例CRKP感染患者的临床资料,分析其感染特点、治疗药物及预后转归等情况.结果13例患者共分离出21株CRKP菌株,血流感染3例,胸水感染4例,手术切口感染1例,肺部感染13例.高龄、机械通气时间延长及气管切开是主要危险因素.13例患者均采用了联合用药,11例以替加环素或多黏菌素b为基础,联合碳青霉烯类或非碳青霉烯类药物;2例使用亚胺培南联合阿米卡星.13例患者死亡8例.结论心胸外科术后继发院内CRKP感染的耐药谱广、临床可选用的抗菌药物有限,预后不佳.Objective To investigate the clinical features and therapeutic effects of carbapenem-resistant Klebsiella pncumoniae(CRKP)infection in patients after cardiothoracic surgery and to provide evidence for clinical rational selection of antibiotics.Methods The clinical data of l3 cases of CRKP infection from June 2018 to January 2019 in the Cardiothoracic Surgery Department of Xinhua Hospital Affiliated to Shanghai Jiaotong University were retrospectively analyzed.The infection characteristics,therapeutic drugs and prognosis outcomes were analyzed.Results A total of 21 CRKP strains were isolated from 13 patients,3 patients with bloodstream infection,4 patients with pleural fluid infection,l patient with surgical incision infection and 13 patients with pulmonary infection.Old age,prolonged mechanical ventilation and tracheotomy are major risk factors.All 13 patients were treated with a combination.The treatment regimen of ll patients was based on tigecycline or polymyxin b combined with carbapenems or non-carbapene.Two cases used carbapenems in combination with amikacin.Eighteen patients died in 8 patients.Conclusion Cardiothoracic surgery has a wide spectrum of drug resistance to CRKP infection,limited clinical antibiotics and poor prognosis.

关 键 词：碳青霉烯类 肺炎克雷伯菌 多重耐药 心胸外科术后 

分 类 号：R654.2[医药卫生—外科学]