碳青霉烯耐药肺炎克雷伯菌下呼吸道医院感染流行病学分析  

Epidemiological analysis of lower respiratory nosocomialinfection induced by carbapenem-resistant Klebsiella pneumonia

作　　者：阚唯一 王创业 周妍希 朱可可 张晨敏 顾兵 康海全 Kan Weiyi(School of Medical Technology,Xuzhou Medical University,Xuzhou,Jiangsu,221004,China)

机构地区：[1]徐州医科大学医学技术学院,江苏徐州221004 [2]徐州医科大学附属医院,江苏徐州221002

出　　处：《齐齐哈尔医学院学报》2021年第16期1430-1434,共5页Journal of Qiqihar Medical University

基　　金：江苏省大学生创新创业训练计划(201910313034Z)。

摘　　要：目的分析碳青霉烯类肺炎克雷伯菌(CRKP)引起的医院内下呼吸道感染的流行病学特征,为CRKP医院内感染提供理论依据。方法收集2018年1—12月在某三级甲等教学医院医院内下呼吸道感染CRKP患者的临床资料,并进行流行病学调查分析。研究对象为下呼吸道医院感染患者痰液、肺泡灌洗液培养CRKP的病例。通过PCR和DNA测序检测耐药基因。通过多基因座序列分型(MLST)分析CRKP菌株的细菌克隆相关性。结果2018年医院CRKP感染年发病率为5.71/10000出院人数(104/182,243×10000),每10万患者住院日为5.53(104/1,879,650×100000)。104例研究对象中,65岁以上占46.16%(48/104),既往史中高血压42.83%(44/104),ICU入住史27.89%(29/104),抗菌药物暴露史为88.46%(92/104)。最常见的MLST分型为ST11(79/104,76.0%),其次是ST48(9/104,8.65%)。KPC-2(101/104,97.12%)是主要的碳青霉烯酶,AmpC-酶和超广谱β-内酰胺酶分别以DHA-1、CTX-M-65为主。结论医院内下呼吸道感染的CRKP菌以中产生KPC-2的ST11肺炎克雷伯菌最为常见。长期的、系统的检测以及严格的控制措施是遏制此类细菌传播的重要措施。Objective To analyze the epidemiological characteristics of lower respiratory tract infection caused by carbapenemase resistant K.pneumoniae(CRKP)and provide theoretical basis for CRKP hospital infection.Methods From January to December 2018,the clinical data of patients suffered with lower respiratory tract nosocomialinfection caused by CRKP was collected in a third-grade teaching hospital,and epidemiological investigation was conducted.The subjects were CRKP cultured in sputum and alveolar lavage fluid of hospital patients with lower respiratory tract infection.Drug resistance genes were detected by PCR and DNA sequencing.The bacterial clonal correlation of the CRKP strain was analyzed by Multilocus sequence typing(MLST).Results In 2018,the annual incidence of CRKP infection in hospitals was 5.71/10000 discharges(104/182,243×10000),and the hospitalization days per 100,000 patients was 5.53(104/1,879,650×100000).Of the 104 isolates,46.16%(48/104)were over 65 years old;among the patients with previous history,42.83%(44/104)with hypertension,27.89%(29/104)were ever hospitalized in ICU,and 88.46%were exposed to antibiotics(92/104).The most common MLST classification was ST11(79/104,76.0%),followed by ST48(9/104,8.65%).KPC-2(101/104,97.12%)was the main carbapenemase,and AmpC-enzyme and extended-spectrumβ-lactamase were mainly DHA-1 and CTX-M-65,respectively.Conclusions The most commonCRKP strain that induces lower respiratory tract infection in hospital is ST11 Klebsiella pneumoniae that producing KPC-2.Long-term,systematic testing and strict control measures are important measures to control the spread of such bacteria.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 ST11 医院感染 细菌耐药 

分 类 号：R446.1[医药卫生—诊断学]