耐多黏菌素和碳青霉烯类肺炎克雷伯菌的危险因素分析  

Risk factors of infection with polymyxin resistant and carbapenemase-resistant Klebsiella pneumoniae

作　　者：徐茵[1] 王玉月[2] 朱丽丽 金丹 鲍金凤 何燕娟 史伟峰[2] 袁晓峰 刘惕[1] Xu Yin;Wang Yuyue;Zhu Lili;Jin Dan;Bao Jinfeng;He Yanjuan;Shi Weifeng;Yuan Xiaofeng;Liu Ti(Infection Management Department,The Third Affiliated Hospital of Soochow University,Changzhou 213003,Jiangsu Province,China;Microbiology Unit of Clinical Laboratory,The Third Affiliated Hospital of Soochow University,Changzhou 213003,Jiangsu Province,China;Department of Orthopedics,The Third Affiliated Hospital of Soochow University,Changzhou 213003,Jiangsu Province,China)

机构地区：[1]苏州大学附属第三医院感染管理处,常州213003 [2]苏州大学附属第三医院检验科微生物室,常州213003 [3]苏州大学附属第三医院骨科,常州213003

出　　处：《中华临床感染病杂志》2023年第6期446-451,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：常州市卫健委青苗人才项目(CZQM2023006);常州市科技局、财政局第七批科技计划项目(CE20225036)。

摘　　要：目的探究耐多黏菌素和碳青霉烯类肺炎克雷伯菌(polymyxin resistant and carbapenemase-resistant Klebsiella pneumoniae,PR-CRKP)的危险因素。方法收集2020年7月至2023年10月在苏州大学附属第三医院住院期间检出CRKP的患者资料,根据对多黏菌素B的药敏试验结果分为CRKP组和PR-CRKP组,回顾性分析患者的一般情况、入院前6个月抗菌药物暴露情况、入院时临床检测指标、检出目标菌时抗菌药物使用情况、住院时间和侵入性操作时间等,采用多因素Logistic回归分析PR-CRKP的危险因素。采用SPSS 26.0软件对数据进行统计分析。结果共纳入CRKP感染患者170例,CRKP组123例,PR-CRKP组47例。单因素分析显示,与CRKP组相比,PR-CRKP组的年龄更高(Z=-2.186,P=0.029),入院前6个月半合成青霉素类、碳青霉烯类、多黏菌素类和喹诺酮类药物的暴露史比例更高(χ^(2)=3.930、5.414、11.939、8.478,P值均<0.05),入院时诊断为感染的比例和血尿素氮水平更高(χ^(2)=7.268,Z=-2.406,P=0.007和0.016),血红蛋白水平更低(t=2.641,P=0.009),住院时间和气管插管、导尿管、深静脉置管时间更长(Z=-4.243、-4.660、-5.341、-4.583,P值均<0.001),碳青霉烯类药物和多黏菌素B使用时间更长(Z=-4.757和-7.554,P值均<0.001),合并耐喹诺酮类肠杆菌(quinolone-resistant Escherichia coli,QREC)和碳青霉烯类耐药革兰阴性菌(carbapenem-resistant organism,CRO)感染、血流感染和收治重症监护病房的比例均更高(χ^(2)=33.737、42.041、5.426、12.991,P<0.05或<0.01)。多因素分析显示,多黏菌素B使用时间(OR=1.179,95%CI 1.059~1.312,P=0.003)、合并QREC感染(OR=5.357,95%CI 2.100~13.669,P<0.001)和合并CRO感染(OR=3.302,95%CI 1.146~9.514,P=0.027)是PR-CRKP的独立危险因素。结论长时间使用多黏菌素B是PR-CRKP的独立危险因素,混合QREC和CRO感染可增加PR-CRKP的风险。ObjectiveTo investigate the risk factors of infection with polymyxin resistant and carbapenemase-resistant Klebsiella pneumoniae(PR-CRKP).MethodsA total of 170 patients with CRKP infection admitted in the Third Affiliated Hospital of Soochow University from July 2020 to October 2023 were enrolled,including 123 cases of CRKP infection and 47 cases of PR-CRKP infection.The general conditions,exposure of antibacterial drugs 6 months before admission,laboratory test indicators at admission,antibacterial drug use when target bacteria were detected,length of hospital stay and time of invasive procedures in two groups were retrospectively analyzed.The risk factors of PR-CRKP infection were analyzed with univariate and multivariate logistic regression.SPSS 26.0 software was used to analyze the data.ResultsUnivariate analysis showed that compared with the CRKP group,the average age of patients in PR-CRKP group was older(Z=-2.186,P=0.029),the proportion of patients with exposure history to semisynthetic penicillins,carbapenems,polymyxins,and quinolones 6 months before admission was higher(χ^(2)=3.930,5.414,11.939,8.478,all P<0.05),the proportion of infections diagnosed at admission and blood urea nitrogen levels(χ^(2)=7.268,Z=-2.406,P=0.007 and 0.016)was higher,the hemoglobin level(t=2.641,P=0.009)was lower,the length of hospital stay was longer,the rates of tracheal intubation,urinary catheter,and deep vein catheterization were higher(Z=-4.243,-4.660,-5.341,-4.583,all P<0.001),the duration of carbapenem and polymyxin B use was longer(Z=-4.757,-7.554,both P<0.001),the proportion of combined quinolone-resistant Escherichia coli(QREC)and carbapenem-resistant organism(CRO)infections and bloodstream infections,and the rate of admission to intensive care units was higher(χ^(2)=33.737,42.041,5.426,12.991,P<0.05 or<0.01).Multivariate analysis showed that time to polymyxin B use(OR=1.179,95%CI 1.059-1.312,P=0.003),combined QREC infection(OR=5.357,95%CI 2.100-13.669,P<0.001)and combined CRO infection(OR=3.302,95%CI 1.146-9.514,P

关 键 词：肺炎克雷伯菌 碳青霉烯类耐药 多黏菌素耐药 喹诺酮耐药 

分 类 号：R446.5[医药卫生—诊断学]