感染泌尿道的肺炎克雷伯菌耐药性及感染耐亚胺培南肺炎克雷伯菌的危险因素分析  

Drug resistance of Klebsiella pneumoniae infecting urinary tract and risk factors of imipenem-resistant Klebsiella pneumoniae infections

作　　者：张宁 李晓丹 周冠兴[2] 韦珍妮 Zhang Ning;Li Xiaodan;Zhou Guanxing;Wei Zhenni(The First Department of Internal Medicine,NO.4 People’s Hospital of Zhanjiang,Zhanjiang 524000,Guangdong,China;Department of Nephrology,Suixi People’s Hospital,Suixi 524300,Guangdong,China)

机构地区：[1]广东省湛江市第四人民医院内一科,广东湛江524000 [2]广东省遂溪县人民医院肾内科,广东遂溪524300

出　　处：《右江民族医学院学报》2022年第1期71-74,89,共5页Journal of Youjiang Medical University for Nationalities

基　　金：广东省湛江市科技计划项目(2020B01178)。

摘　　要：目的探讨泌尿道感染肺炎克雷伯菌(KP)的耐药性及感染耐亚胺培南肺炎克雷伯菌(IRKP)的危险因素。方法检测356株来自于尿液标本KP的药物敏感性。根据药物敏感性结果把KP分为IRKP组和亚胺培南敏感肺炎克雷伯菌(ISKP)组。采用多因素Logistic回归分析感染IRKP的危险因素。结果IRKP占14.33%(51株)。环丙沙星、左旋氧氟沙星、庆大霉素、头孢曲松、头孢西丁、头孢呋辛、头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、氨苄西林/舒巴坦、氨曲南在IRKP组的耐药率明显高于ISKP组(P<0.001)。多因素Logistic回归分析显示,入住ICU≥7d、住院时间≥30d、使用碳青霉烯类抗生素≥7d、留置导尿管≥7d、入院APACHEⅡ评分>20分是感染IRKP的影响因素。结论感染泌尿道KP的耐药形势严峻,特别是IRKP。入住ICU≥7d、住院时间≥30d、使用碳青霉烯类抗生素≥7d、留置导尿管≥7d、入院APACHEⅡ评分>20分均是IRKP感染泌尿道的独立危险因素。Objective To investigate the drug resistance of Klebsiella pneumonia(KP)infecting urinary tract and risk factors of imipenem-resistant Klebsiella pneumoniae(IRKP)infections.Methods This study detected the drug sensitivity of 356 KP strains from urine samples.According to the drug sensitivity results,the KP was divided into the IRKP group and the imipenem-sensitive Klebsiella pneumoniae(ISKP)group.Multivariate logistic regression was used to analyze the risk factors of IRKP infections.Results IRKP accounted for 14.33%(51 strains)of total KP.Ciprofloxacin,levofloxacin,gentamicin,ceftriaxone,cefoxitin,cefuroxime,ceftazidime,cefepime,piperacillin/tazobactam,Cefoperazone/sulbactam,ampicillin/sulbactam and aztreonam had significantly higher drug resistance in the IRKP group than in the ISKP group(P<0.001).Multivariate logistic regression analysis showed that admission to ICU≥7 days,hospitalization duration≥30 days,use of carbapenem antibiotics≥7 days,indwelling catheter≥7 days and admission APACHEⅡscore>20 were influencing factors of IRKP infection.Conclusion The drug resistance of KP infecting urinary tract is serious,especially IRKP.Admission to ICU≥7 days,hospitalization duration≥30 days,use of carbapenem antibiotics≥7 days,indwelling catheter≥7 days and admission APACHEⅡscore>20 are independent risk factors for IRKP infections in urinary tract.

关 键 词：肺炎克雷伯菌 耐药性 亚胺培南 危险因素 

分 类 号：R378.99[医药卫生—病原生物学]