重症监护室与普通病房碳青霉烯类耐药肺炎克雷伯菌感染与耐药性分析  

Analysis of Carbapenem-resistant Klebsiella pneumoniae infection and drug resistance in intensive care unit and general ward

作　　者：宋晓超 乔美珍[1] 赵丽娜[2] 陈凯[1] 钱雪峰[1] 吴琛[1] 金美娟[1] SONG Xiao-chao;QIAO Mei-zhen;ZHAO Li-na;CHEN Kai;QIAN Xue-feng;WU Chen;JIN Mei-juan(The First Affiliated Hospital of Suzhou University,Suzhou,Jiangsu 215006,China)

机构地区：[1]苏州大学附属第一医院感染管理处,江苏苏州215006 [2]苏州大学附属第一医院微生物室,江苏苏州215006

出　　处：《中华医院感染学杂志》2020年第22期3372-3377,共6页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金(青年基金)资助项目(81702065);江苏省青年基金资助项目(BK20170364)。

摘　　要：目的探讨重症监护室(ICU)与普通病房碳青霉烯类耐药肺炎克雷伯菌(CRKP)医院感染感染部位、检出情况及耐药性特点,为临床感染控制合理用药及治疗提供数据支持。方法回顾性调查2016年1月-2019年12月苏州大学附属第一医院239 836例住院患者的临床资料和微生物信息,其中ICU诊断为CRKP医院感染204例,普通病房120例,分析两组CRKP感染部位、检出情况及耐药性。结果 CRKP医院感染373例次,其中ICU 243例次(65.15%);普通病房130例次(34.85%)。两组患者CRKP感染部位均以下呼吸道为主。ICU组呼吸机相关性肺炎和菌血症CRKP感染率高于普通病房。ICU组CRKP总感染检出率为37.66%(1 527/4 055)高于普通病房组(P<0.001)。两组医院感染CRKP对常用抗菌药物的耐药率均高于碳青霉烯类敏感的肺炎克雷伯菌(CSKP)(P<0.05)。两组医院感染CRKP对多数常用抗菌药物呈高度耐药性,仅对替加环素耐药率较低,分别为17.17%和15.04%,其次为磺胺甲噁唑/甲氧苄啶。CSKP对多数常用抗菌药物均较为敏感,且在普通病房耐药率高于ICU,除哌拉西林外,普通病房CSKP耐药率均<60%,ICU组均<40%。CSKP对头孢他啶、头孢吡肟、左氧氟沙星、环丙沙星、莫西沙星、诺氟沙星、庆大霉素和氨曲南较为敏感(耐药率<30%),其次对多数头孢菌素和四环素的耐药率在25.00%~56.15%之间,且普通病房均高于ICU组(P<0.05)。结论 ICU与普通病房CRKP医院感染均以下呼吸道为主,ICU呼吸机相关肺炎和菌血症较高。ICU内CRKP感染检出率较高,两组间耐药率无统计学差异,但CSKP在普通病房耐药率多高于ICU,应加强CRKP感染分布、检出和耐药监测,科学合理用药,有效控制感染和减缓碳青霉烯类耐药过快增长和传播。OBJECTIVE To investigate the nosocomial infection site, detection status and drug resistance characteristics of carbapenem-resistant Klebsiella pneumoniae(CRKP) in the intensive care unit(ICU) and general ward, so as to provide reference for the rational use and treatment of clinical infection control. METHODS The clinical data and microbial information of 239 836 inpatients in the First Affiliated Hospital of Soochow University from January 2016 to October 2019 were retrospectively analyzed, among which, ICU diagnosed 204 cases of CRPK nosocomial infection and 120 cases in general ward, the CRPK infection sites, detection status and drug resistance rate of the two groups were analyzed. RESULTS There were 373 cases of CRKP hospital infection, including 243 cases(65.16%) in the ICU and 130 cases(34.85%)in the general ward. The CRKP infection sites of the two groups of patients were mainly lower respiratory tract. The CRKP infection rate of ventilator-associated pneumonia and bacteremia in the ICU group was higher than that in general ward. The total infection detection rate of CRKP infection in the ICU group was 37.66%(1 527/4 055), significantly higher than that in general ward group(P<0.001). The drug resistance rate of CRKP to commonly used antibacterial drugs in the two groups of hospital infections was significantly higher than that of carbapenem-sensitive K. pneumonia(CSKP)(P<0.05). The hospital-infected CRKP of the two groups was highly resistant to most of the commonly used clinical antibiotics, only the resistance rate to tegacyclin was lower, 17.17% and 15.04% respectively, followed by sulfamethoxazole/trimethoprim. CSKP was more sensitive to most commonly used antibiotics, and the drug resistance rate in general ward was higher than that in ICU. Except for piperacillin, the drug resistance rate of CSKP in general ward was lower than 60% and that in ICU was less than 40%. CSKP was more sensitive to ceftazidime, cefepime, levofloxacin, ciprofloxacin, moxifloxacin, norfloxacin, gentamicin and aztreonam(res

关 键 词：重症监护病房 普通病房 碳青霉烯类耐药肺炎克雷伯菌 感染部位 耐药性 

分 类 号：R378[医药卫生—病原生物学]