儿科碳青霉烯类耐药肺炎克雷伯菌感染危险因素及其耐药性  

Risk factors for carbapenem-resistant Klebsiella pneumoniae infection in pediatrics department and drug resistance

作　　者：杨欣[1] 鲁利群[1] 黄莉[1] 贺静[1] 汪燕[1] 王旭[1] 邓国清[1] YANG Xin;LU Li-qun;HUANG Li;HE Jing;WANG Yan;WANG Xu;DENG Guo-qing(The First Affiliated Hospital of Chengdu Medical College,Chengdu,Sichuan 610500,China)

机构地区：[1]成都医学院第一附属医院儿科,四川成都610500

出　　处：《中华医院感染学杂志》2020年第22期3470-3473,共4页Chinese Journal of Nosocomiology

基　　金：四川省科技厅应用基础研究计划基金资助项目(2018JY0301)。

摘　　要：目的分析儿科感染碳青霉烯类耐药肺炎克雷伯菌(CRKP)患儿的耐药特点及危险因素。方法收集2018年1月-2019年12月成都医学院临床医学院第一附属医院儿科肺炎克雷伯菌感染患儿的临床资料,分析患儿感染CRKP的危险因素。收集同期的CRKP,采用琼脂平板稀释法检测细菌的敏感性,采用Carba NP法检测菌株产碳青霉烯酶类型,并采用聚合酶链反应进行扩增鉴定。结果单因素分析发现使用中心静脉导管、分离前使用碳青霉烯类药物和住院时间>21 d差异具有统计学意义(P<0.05)。多因素回归分析显示分离前使用碳青霉烯类抗菌药物是患儿感染CRKP的独立危险因素。CRKP对喹诺酮类和氨基糖苷类具有较高的敏感性,而对其他实验用β-内酰胺类抗菌药物全部耐药。所有碳青霉烯类耐药菌株均产碳青霉烯酶,其中NDM-1是最常见的碳青霉烯酶耐药基因,其次为KPC-2和IMP-4基因。结论儿科CRKP的耐药率高,对住院时间长且使用碳青霉烯类抗菌药物的危重患儿应加强无菌操作,合理使用抗菌药物,以降低CRKP的感染概率。OBJECTIVE To investigate the drug resistance of carbapenem-resistant Klebsiella pneumoniae( CRKP) strains isolated from pediatrics department and analyze the risk factors for CRKP infection. METHODS The clinical data were collected from the children with K.pneumoniae infection who were treated in the First Affiliated Hospital of Chengdu Medical College from Jan 2018 to Dec 2019, and the risk factors for the CRKP infection were analyzed. Meanwhile, the CRKP strains were collected, the sensitivity of the strains was detected by using agar plate dilution method, the types of carbapenemases were detected by means of Carba NP, and the carbapenemases were amplified and identified through polymerase chain reaction. RESULTS Univariate analysis showed that there were significant differences in the use of central venous catheter, use of carbapenems before isolation and length of hospital stay more than 21 days(P<0.05). Multivariate regression analysis indicated that the use of carbapenems before isolation was the independent risk factor for the CRKP infection in the children. The CRKP strains were highly susceptible to quinolones and aminoglycosides and were completely resistant to other tested β-lactams. All of the carbapenem-resistant strains produced carbapenemases, NDM-1 was the most common carbapenemases resistance gene, followed by KPC-2 and IMP-4. CONCLUSION The drug resistance rate of the CRKP strains isolated from the pediatrics department is high. It is necessary to strengthen aseptic operation for the critically ill children with long length of hospital stay and use of carbapenems and reasonably use antibiotics so as to reduce the incidence of CRKP infection.

关 键 词：儿科 碳青霉烯类耐药肺炎克雷伯菌 耐药 危险因素 碳青霉烯酶基因 

分 类 号：R378.996[医药卫生—病原生物学]