尿路感染耐碳青霉烯类肺炎克雷伯菌的临床特点及危险因素分析  

Analysis of Clinical Characteristics and Risk Factors of Carbapenem-resistant Klebsiella Pneumoniae in Urinary Tract Infection

作　　者：徐林飞[1] XU Lin-fei(Department of Urology Surgery,Taizhou Municipal Hospital,Taizhou 318000,Zhejiang,China)

机构地区：[1]台州市立医院泌尿外科,浙江台州318000

出　　处：《医学信息》2022年第21期46-49,共4页Journal of Medical Information

基　　金：浙江省自然科学基金项目(编号:LY12H05009);2020年浙江省台州市科技项目(编号:20ywa33)。

摘　　要：目的 对我院尿路感染耐碳青霉烯类肺炎克雷伯菌(CRKP)的临床特点、耐药性及危险因素进行分析,为临床防控提供依据。方法 选择2018年6月-2019年6月我院尿液培养分离出的98株肺炎克雷伯菌(Kpn),收集标本对应的患者临床资料,进行Kpn鉴定与培养、药物敏感试验,按药敏结果分为碳青霉烯耐药组(CRKP)和敏感组(CSKP),分析其临床特点及危险因素。结果 98株Kpn中有40株是CRKP(40.82%);年龄≥65岁(87.50%)、糖尿病(37.50%)、经尿道操作史(67.50%)及抗生素暴露史患者(95.00%)比例均超过30.00%;尿路感染的CRKP对氨苄西林、头孢曲松、哌拉西林舒巴坦钠的耐药率均达到100.00%,对替加环素(10.00%)、多粘菌素(15.00%)的耐药率较低,低于对碳青霉烯类敏感的CSKP(P<0.05);CRKP组患者与CSKP组患者的细菌清除率比较,差异有统计学意义(P<0.05),两组死亡率比较,差异无统计学意义(P>0.05)。结论 尿路感染CRKP对抗生素普遍耐药,但对替加环素、多粘菌素仍敏感,建议联合用药。另外,对于年龄大、基础疾病多的患者应减少经尿道操作、大量广谱抗生素的暴露,同时按照药敏试验结果选用敏感抗菌药物降低尿路感染CRKP的发生。Objective To analyze the clinical characteristics, drug resistance and risk factors of carbapenem-resistant Klebsiella pneumoniae(CRKP)in urinary tract infection in our hospital, and to provide evidence for clinical prevention and control. Methods A total of 98 strains of Klebsiella pneumoniae(Kpn) isolated from urine culture in our hospital from June 2018 to June 2019 were selected. The clinical data of the patients corresponding to the specimens were collected for Kpn identification and culture and drug sensitivity test. According to the results of drug sensitivity,they were divided into carbapenem-resistant group(CRKP) and sensitive group(CSKP), and their clinical characteristics and risk factors were analyzed.Results Totally 40 of 98 strains of Kpn were CRKP(40.82%);the proportion of patients with age ≥65 years(87.50%), diabetes(37.50%),history of transurethral operation(67.50%) and history of antibiotic exposure(95.00%) was more than 30.00%. The resistance rates of CRKP to ampicillin, ceftriaxone and piperacillin sulbactam sodium in urinary tract infection were 100.00%, and the resistance rates to tigecycline(10.00%)and polymyxin(15.00%) were lower than those of carbapenem-sensitive CSKP(P<0.05). There was significant difference in bacterial clearance rate between CRKP group and CSKP group(P <0.05). There was no significant difference in mortality between the two groups( P >0.05).Conclusion CRKP in urinary tract infection is generally resistant to antibiotics, but it is still sensitive to tigecycline and polymyxin. It is recommended to combine drugs. In addition, for patients with older age and more underlying diseases, transurethral operation and exposure to a large number of broad-spectrum antibiotics should be reduced, and sensitive antibiotics should be selected according to the results of drug sensitivity test to reduce the occurrence of CRKP in urinary tract infection.

关 键 词：尿路感染 耐碳青霉烯类肺炎克雷伯菌 药物敏感试验 

分 类 号：R446.5[医药卫生—诊断学]