肠道定植和感染耐碳青霉烯肺炎克雷伯菌株监测及分子流行病学特征  

Surveillance and epidcrmiological characteristics of patients with intestinal colonization and infection of carbapenem-resistance Klebsiella pneumoniae

作　　者：温鸿[1] 夏小琴 金小亚[1] 陈栎江[3] 夏炎火[4] 张其霞[4] 陈晓青[4] 叶媛媛[1] WEN Hong;XIA Xiao-qing;JIN Xiao-ya;CHEN Li-jiang;XIA Yan-huo;ZHANG Qi-xia;CHEN Xiao-qing;YE Yuan-yuan(The First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China;不详)

机构地区：[1]温州医科大学附属第一医院院内感染管理处,浙江温州325000 [2]温州市中心医院心血管内科,浙江温州325000 [3]温州医科大学附属第一医院检验科,浙江温州325000 [4]温州医科大学附属第一医院重症监护室,浙江温州325000

出　　处：《中华医院感染学杂志》2024年第19期2894-2900,共7页Chinese Journal of Nosocomiology

基　　金：温州市科学技术局基金资助项目(Y2020974)。

摘　　要：目的研究肠道定植和感染耐碳青霉烯类肺炎克雷伯菌(CRKP)流行病学特征和医院感染危险因素,探索适合临床实际且能有效降低CRKP流行和感染的防控策略。方法筛选温州医科大学附属第一医院2018-2022年的CRKP肠道定植患者,分析比较仅定植和定植后发生医院感染人群的临床特征和感染危险因素。通过全基因组测序分析CRKP菌株的分子流行病学特征,包括碳青霉烯酶型、毒力基因表型、荚膜血清型和多位点序列分型;制订落实符合医院实际的CRKP肠道监测和感染防控改进策略,持续性监测CRKP肠道定植率、检出率和医院感染率等数据,确保CRKP医院全流程管理和防控有成效。结果46例CRKP定植患者中有16例(34.78%)发生医院感染;昏迷(OR=9.000,95%CI:1.92242.139,P=0.005)和使用糖皮质激素(OR=0.115,95%CI:0.013~0.995,P=0.005)是发生医院感染的影响因素(P<0.05);CRKP菌株耐药水平高,对替加环素和多黏菌素100%敏感;菌株主要携带bla_(KPC)-2碳青霉烯酶基因,荚膜血清型以K14和K64为主,毒力基因rmpA在感染患者中携带率较高(P<0.05),多位点序列分型主要以ST11和ST15为主;有效改进CRKP感染防控措施,包括组织管理、肠道精准筛查及信息化管理等;医院CRKP感染防控成效显著,肠道筛查阳性率、CRKP检出率、CRKP医院感染率均持续下降(P<0.05)。结论CRKP肠道定植患者存在因各种诊疗中感染危险因素的作用而发生肠道外医院感染的高风险,定植和医院感染菌株在毒力方面存在差异。改进的肠道精准筛查和信息化全流程管理等防控策略可有效降低CRKP的传播流行和交叉感染。OBJECTIVE To study the epidemiological characteristics of intestinal colonization of carbapenem-resistant Klebsiella pneumoniae(CRKP)and the risk factors of healthcare associated infections(HAIs),and to explore the prevention and control strategies that are suitable for clinical practice and can effectively reduce the prevalence of CRKP and infections.METHODS Inpatients with CRKP intestinal colonization in the First Affiliated Hospital of Wenzhou Medical University between 2018 and 2020 were screened,the clinical characteristics and infection risk factors of the population with hospital-acquired infections only and after colonization were analyzed and compared.The molecular epidemiological characteristics of CRKP strains were analyzed by whole-genome sequencing,including carbapenemase type,virulence gene,capsular serotype and multi-locus sequence typing(MLST).CRKP intestinal surveillance and infection prevention and control improvement strategies in line with the actual situation of hospitals were formulated and implemented,and the data on CRKP intestinal colonization rate,detection rate and hospital infection rate were continually monitored in order to ensure the effectiveness of the whole process of CRKP hospital management and prevention and control.RESULTS Hospital-acquired infections occurred in 16(34.78%)of 46CRKP colonized patients.Coma,(OR=9.000,95%CI:1.922-42.139,P=0.005)and glucocorticoids(OR=0.115,95%CI:0.013-0.995,P=0.005)were influencing factors for HAIs.CRKP strains had a high level of resistance to drugs,and were 100%sensitive to tigecycline and polymyxin.The strains mainly carried the bla kpc2 carbapenemase gene,the capsular serotypes were dominated by K14 and K64,the virulence gene rmpA was carried at a higher rate in infected group(P<0.05),and the multilocus sequence typing was mainly dominated by ST11 and ST15.The IPC improvement measures of CRKP achieved remarkable results,including unified management organization,precise screening and informatization management etc.The effectiveness of CRKP i

关 键 词：医院感染 耐碳青霉烯肺炎克雷伯菌 定植 分子流行病学 监测 同源性 

分 类 号：R378[医药卫生—病原生物学]