耐碳青霉烯类肺炎克雷伯菌所致呼吸机相关性肺炎的临床特征及耐药性  

Clinical characteristics and drug resistance of ventilator-associated pneumonia caused by carbidenes-resistant Klebisella pneumoniae

作　　者：白佳玉 李云霞[2] 王琦[3] BAI Jia-yu;LI Yun-xia;WANG Qi(Department of Clinical Laboratory,Affiliated Central Hospital of Shenyang Medical College,Shenyang 110024,China)

机构地区：[1]沈阳医学院附属中心医院检验科,110024 [2]沈阳医学院附属中心医院呼吸内科,110024 [3]中国医科大学生命科学学院生理学教研室,110024

出　　处：《中国实用医药》2020年第31期17-19,共3页China Practical Medicine

摘　　要：目的评估耐碳青霉烯类肺炎克雷伯菌(CRKP)所致呼吸机相关性肺炎(VAP)的临床特征及耐药性状况。方法 79例CRKP所致VAP患者,依据预后状况分成良好组(48例)和不佳组(31例),采集两组患者的呼吸道分泌物标本,分离CRKP菌株,开展耐药试验。统计所有患者的药敏试验分析结果 ,对比两组患者的临床资料差异。结果药敏试验证实:CRKP所致VAP患者的病原菌对氨曲南、哌拉西林/他唑巴坦、头孢曲松、左氧氟沙星、环丙沙星、亚胺培南的耐药率均为100.00%。其他耐药率低于100.00%的抗菌药物中,菌株对替加环素的耐药率最低,为0;庆大霉素、阿米卡星及厄他培南的耐药率也处于较低水平。两组患者的使用糖皮质激素占比、伴高血压占比、伴糖尿病占比比较,差异均无统计学意义(P>0.05);良好组患者年龄≥60岁占比为37.50%、机械通气时长≥7 d占比为31.25%、抗菌药物使用时长≥7 d占比为27.08%、CD3+细胞计数≥600 cells/μl占比为31.25%,均低于不佳组的67.74%、64.52%、61.29%、70.97%,差异均具有统计学意义(P<0.05)。结论 CRKP所致VAP患者对多种药物耐药,而对替加环素、庆大霉素等药物的耐药率较低。这类患者预后状况的影响因素较多。Objective To evaluate the clinical characteristics and drug resistance of ventilatorassociated pneumonia(VAP) caused by carbidenes-resistant Klebisella pneumoniae(CRKP). Methods A total of 79 patient with VAP caused by CRKP were divided into good group(48 cases) and poor group(31 cases) according to their prognosis. Respiratory secretions samples of the two groups were collected, CRKP strains were isolated to carry out drug resistance tests. Drug sensitivity test results of all patients were analyzed and collected, and the clinical data of two groups were compared. Results The drug susceptibility test confirmed that the pathogenic bacteria of VAP patients caused by CRKP had a resistance rate of 100.00% to aztreonam, piperacillin/tazobactam, ceftriaxone, levofloxacin, ciprofloxacin, and imipenem. Among the other antibiotics with drug resistance rate lower than 100%, the resistance rate to tigecycline was the lowest as 0;the drug resistance rate of gentamicin, amikacin and ertapenem was also at a low level. There was no statistically significant difference in the proportions of glucocorticoids, hypertension and diabetes between the two groups(P>0.05);in the good group, the proportion of patients aged≥60 years was 37.50%, the proportion of mechanical ventilation duration≥7 d was 31.25%, the proportion of antibacterial drug use≥7 d was 27.08%, and the proportion of CD3+ cell count≥600 cells/μl was 31.25%, which were all lower than 67.74%, 64.52%, 61.29%, 70.97% of the poor group, and the difference was statistically significant(P<0.05). Conclusion VAP patients caused by CRKP are resistant to many drugs, but the drug resistance rate to tigecycline and gentamicin is low. There are many factors affecting the prognosis of such patients.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 呼吸机相关性肺炎 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R563.1[医药卫生—临床医学]