耐碳青霉烯类肺炎克雷伯菌医院感染96例临床分布 药敏结果及危险因素分析  

Clinical distribution,drug sensitivity results,and risk factors analysis of 96 cases of CRKP hospital infection

作　　者：邱成章 黄霖 曾知雯 Qiu Chengzhang;Huang Lin;Zeng Zhiwen(Department of Laboratory,Nanfeng County People′s Hospital,Fuzhou,Jiangxi 344500,China;Department of Laboratory,Fuzhou First People′s Hospital,Fuzhou,Jiangxi 344000,China)

机构地区：[1]江西省南丰县人民医院检验科,江西抚州344500 [2]江西省抚州市第一人民医院检验科,江西抚州344000

出　　处：《实用医技杂志》2023年第5期330-333,共4页Journal of Practical Medical Techniques

摘　　要：目的分析96例耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染临床分布、药敏结果及危险因素。方法回顾性分析江西省南丰县人民医院和江西省抚州市第一人民医院2020年1月至2022年12月96例医院感染肺炎克雷伯菌患者临床资料,按照碳青霉烯类药物敏感性分为CRKP组35例和碳青霉烯类敏感肺炎克雷伯菌(CSKP)组61例,分析CRKP组病原菌临床分布及耐药性,比较2组患者临床资料,分析医院感染CRKP的危险因素。结果35株CRKP样本主要来源于痰液17株(48%),其次为血液7株(20%),主要来源科室为重症监护室14株(40%)、儿科7株(20%),61株CSKP样本主要来源于痰液32株(52%)、血液10株(16%),主要来源科室为呼吸内科17株(23%)、普外科13株(21%)等;35株CRKP对厄他培南、亚胺培南的耐药率为100%,对美罗培南、头孢哌酮/舒巴坦、环丙沙星的耐药率分别为97%、91%和91%,均对替加环素敏感,对其他抗菌药物呈现不同程度耐药;CRKP组患者年龄、感染部位、合并糖尿病、侵入性操作、住院时长、使用碳青霉烯类药物、联合使用抗菌药物与CSKP组比较,差异均有统计学意义(P<0.05);Logistic分析结果显示,年龄≥60岁、合并糖尿病、侵入性操作、住院>14 d、使用碳青霉烯类药物、联合使用抗菌药物均为CRKP医院感染的影响因素(P<0.05)。结论当前医院感染CRKP病原体主要来源于重症监护室、儿科等科室,对多种抗菌药物耐药性均较高,年龄、糖尿病、侵入性操作、住院时长、使用碳青霉烯类药物、联合使用抗菌药物均为CRKP医院感染的影响因素,需对相关因素加以重视并加强管控,以降低CRKP医院感染风险。Objective To analyze the clinical distribution,drug sensitivity results,and risk factors of 96 cases of carbapenem resistant Klebsiella pneumoniae(CRKP)hospital infection.Methods A retrospective analysis was conducted on the clinical data of 96 patients with nosocomial infection of Klebsiella pneumoniae in Nanfeng County People′s Hospital and Fuzhou First People′s Hospital from January 2020 to December 2022,divided into a CRKP group of 35 cases and a carbapenem sensitive Klebsiella pneumoniae(CSKP)group of 61 cases based on their carbapenem drug sensitivity.The clinical distribution and drug resistance of pathogenic bacteria in the CRKP group were analyzed,and the clinical data of the two groups of patients were compared to analyze the risk factors of hospital infection with CRKP.Results Thirty-five CRKP samples were mainly sourced from sputum(48%,17 cases),followed by blood(20%,7 cases),mainly from ICU(40%,14 cases)and pediatrics(20%,7 cases).Sixty-one CSKP samples were mainly sourced from sputum(52%,32 cases)and blood(16%,10 cases),mainly from respiratory medicine(23%,17 cases)and general surgery(21%,13 cases).The drug resistance rate of 35 CRKPs to ertapenem and imipenem was 100%,and to meropenem,cefoperazone/sulbactam and ciprofloxacin were 97%,91%and 91%respectively,all of which were susceptible to tigecycline and showed varying degrees of resistance to other antibiotics.The age,site of infection,comorbid diabetes,invasive procedures,length of hospital stay,use of carbapenems,and combined use of antibiotics in the CRKP group were all statistically significant when compared with those in the CSKP group(P<0.05).Logistic analysis showed that age≥60 years,comorbid diabetes,invasive procedures,hospitalization>14 days,use of carbapenems,and combined use of antibiotics were the influencing factors of hospital infection in CRKP(P<0.05).Conclusion At present,the pathogens of hospital infection CRKP mainly come from ICU,pediatrics and other departments,and are highly resistant to many kinds of antibiotics.Age,di

关 键 词：肺炎克雷伯菌 交叉感染 抗药性 细菌 危险因素 

分 类 号：R446.5[医药卫生—诊断学]