2017~2019年某医院急诊科碳青霉烯类耐药肺炎克雷伯菌分布及危险因素  

Analysis of distribution and risk factors of carbapenem-resistant Klebsiella pneumoniae in emergency department of a hospital from 2017 to 2019

作　　者：温伟[1] 艾效曼[2] 陈曦[1] 张新超[1] Wen Wei;AI Xiao-man;Chen Xi;Zhang Xin-chao(Emergency Department,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院国家老年医学中心中国医学科学院老年医学研究院急诊科,北京100730 [2]北京医院国家老年医学中心中国医学科学院老年医学研究院检验科,北京100730

出　　处：《中国急救医学》2021年第10期874-878,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的了解北京医院急诊科2017~2019年临床分离碳青霉烯类耐药肺炎克雷伯菌(CRKP)分布特点、变化趋势及危险因素。方法收集北京医院急诊科2017年1月至2019年12月从临床送检标本中分离的肺炎克雷伯菌,分析其耐药特点及分布。回顾性分析肺炎克雷伯菌感染患者的临床资料,根据是否存在碳青霉烯类耐药将患者分为CRKP组(n=87)和碳青霉烯类敏感肺炎克雷伯菌(CSKP)组(n=65)。采用二元Logistic回归分析CRKP感染的危险因素。药敏试验采用纸片扩散法(Kirby-Bauer法)。分别按美国临床实验室标准化协会(CLSI)2017年版、2018年版和2019年版对各年药敏试验结果进行判断,采用WHONET 5.6版本和SPSS 25.0软件统计分析数据。结果2017~2019年急诊科送检的病原学标本中分离出肺炎克雷伯菌分别为59株(27.7%)、57株(27.9%)、50株(25.0%),在每年分离出的革兰阴性杆菌中始终排在首位。产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌所占比例稳定在70%左右,CRKP所占比例近三年有下降趋势,基础有呼吸系统疾病、留置中心静脉导管、入住ICU≥5 d及三个月内使用碳青霉烯类药物是CRKP感染的危险因素。结论我院急诊科肺炎克雷伯菌耐药问题严峻,尤其是碳青霉烯类耐药肺炎克雷伯菌检出率高,给临床治疗带来挑战,应加强防控。Objective To investigate the distribution characteristics,changing trends and risk factors of clinically isolated carbapenem-resistant Klebsiella pneumoniae(CRKP) in emergency department of Beijing Hospital from 2017 to 2019.Methods Klebsiella pneumoniae isolated from clinical samples were collected from the emergency department of Beijing Hospital from January 2017 to December 2019.The characteristics and distribution of drug resistance were analyzed.The clinical data of patients infected with Klebsiella pneumoniae were retrospectively analyzed,and the patients were divided into CRKP group(87 cases) and carbapenem-sensitive Klebsiella pneumoniae(CSKP group,65 cases) according to the presence of carbapenem resistance.The risk factors of CRKP infection were analyzed by binary Logistic regression.Kirby-Bauer method was used for drug susceptibility test.The test results of drug sensitivity for each year were judged according to CLSI 2017,2018 and 2019 editions,and WHONET 5.6 and SPSS 25.0 were used for statistical analysis.Results From 2017 to2019,59(27.7%),57(27.9%),50(25.0%) Klebsiella pneumoniae strains were isolated from the pathogenic specimens submitted to the emergency department,respectively,ranking first among all Gram-negative bacilli.The proportion of extended spectrum β-lactamase(ESBLs)-producing Klebsiella pneumoniae remained stable at about 70%.The proportion of CRKP showed a declining trend in recent three years.History of respiratory diseases,central venous catheter indwelling,≥5 days in ICU,the use of carbohydrasene antibiotics within three months were risk factors for CRKP infection.Conclusions Drug resistance of Klebsiella pneumoniae was a serious problem in emergency departments,especially the high detection rate of CRKP,which brought challenges to clinical treatment.Prevention and control should be strengthened.

关 键 词：急诊科 耐药性 碳青霉烯类耐药肺炎克雷伯菌 危险因素 

分 类 号：R446.5[医药卫生—诊断学]