耐碳青霉烯类肺炎克雷伯菌耐药性及临床特征分析  

Analysis of drug resistance and clinical characteristics of carbapenem-resistant Klebsiella pneumoniae

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

机构地区：[1]沈阳医学院附属中心医院检验科,110024 [2]中国医科大学,生命科学学院,生理学教研室,110122

出　　处：《中国实用医药》2020年第34期199-202,共4页China Practical Medicine

摘　　要：目的分析耐碳青霉烯类肺炎克雷伯菌(CRKP)的耐药性及临床特征。方法 65例CRKP感染住院患者为观察对象,采集65株CRKP菌株纳入研究。依据患者的预后状况将其分成良好组(预后良好, 37例)和欠佳组(预后不佳, 28例)。统计患者菌株的标本分布状况,分析CRKP的药敏试验结果 ,对比两组患者的一般资料。结果 65株菌株中, 30株来自痰液标本,占比为46.15%;14株来自血液标本,占比为21.54%;10株来自引流液标本,占比为15.38%;8株来自中段尿标本,占比为12.31%;3株来自脑脊液标本,占比为4.62%。药敏试验结果显示:抗菌药物中, CRKP对替加环素的耐药率最低,为3.08%,复方新诺明次之,其耐药率为76.92%,阿米卡星的耐药率也偏低,为80.00%,其余药物的耐药率均>90%。欠佳组患者的年龄>60岁占比、伴脏器损伤占比、拉丝试验阳性占比分别为71.43%、78.57%、75.00%,均高于良好组的40.54%、16.22%、40.54%,差异均具有统计学意义(P<0.05)。两组患者的伴基础疾病占比、抗生素用药时长>10 d占比、实施手术占比、建立人工气道占比比较,差异均无统计学意义(P>0.05)。结论替加环素治疗CRKP感染的抗菌活性较强。高龄、脏器损伤、高毒力容易增加CRKP感染患者伴不良预后的风险。Objective To analyze the drug resistance and clinical characteristics of carbapenemresistant Klebsiella pneumoniae(CRKP). Methods 65 CRKP strains were collected from 65 hospitalized patients with CRKP infection. According to the prognosis of patients, they were divided into good group(37 cases with good prognosis) and poor group(28 cases with poor prognosis). The distribution of strains in patients was counted, and the drug sensitivity test results of CRKP were analyzed, and the general information of two groups was compared. Results Among the 65 strains, 30 strains came from sputum samples, accounting for 46.15%;14 strains from blood samples, accounting for 21.54%;10 strains from drainage fluid samples, accounting for 15.38%;8 strains from middle urine samples, accounting for 12.31%;3 strains from cerebrospinal fluid samples, accounting for 4.62%. The results of the drug sensitivity test showed that among the antibacterial drugs, CRKP had the lowest resistance rate to tigecycline as 3.08%, followed by compound trimethoprim, with a resistance rate of 76.92%, and the resistance rate of amikacin was also on the low side as 80.00%, and the resistance rates of other drugs were all >90%. The proportions of patients in the poor group with age> 60 years old, with organ damage, and positive wire drawing test were 71.43%, 78.57%, and 75.00%, respectively, which were higher than 40.54%, 16.22%, and 40.54% in the good group, and the differences were statistically significant(P<0.05). There was no statistically significant difference in proportions of patients with underlying diseases, antibiotic medication duration> 10 d, surgery, and artificial airway establishment between the two groups(P>0.05). Conclusion Tigecycline has strong antibacterial activity in treating CRKP infection. Old age, organ damage and high virulence may increase the risk of poor prognosis in patients with CRKP infection.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 耐药性 替加环素 

分 类 号：R446.5[医药卫生—诊断学]