宜昌市肺炎克雷伯菌在骨科创面感染的现状及耐药率增高的危险因素  

Current status and drug resistance analysis of Klebsiella pneumoniae in orthopedic wound infections and the risk factors for the increase of drug resistance rate in Yichang city

作　　者：苏维敏 姚紫州 关涛 曾东 茹能 SU Weimin;YAO Zizhou;GUAN Tao;ZENG Dong;RU neng(Department of Orthopedics,The First College of Clinical Medical Science,China Three Gorges University,Yichang,Hubei 443000,China;不详)

机构地区：[1]宜昌市中心人民医院(三峡大学第一临床医学院)骨科,湖北443000 [2]宜昌市中心人民医院(三峡大学第一临床医学院)检验科,湖北443000

出　　处：《中国骨与关节损伤杂志》2024年第12期1233-1238,共6页Chinese Journal of Bone and Joint Injury

基　　金：湖北省教育厅科学研究计划项目(B2018013);宜昌市医疗卫生研究项目(A21-2-026)。

摘　　要：目的 分析宜昌市肺炎克雷伯菌在骨科创面感染的现状及耐药率增高的危险因素,旨在指导临床合理治疗。方法 回顾性分析2017-01—2022-06宜昌市中心人民医院骨科收治的骨科创面感染肺炎克雷伯菌患者的临床资料,细菌培养及菌种鉴定根据《临床微生物学检验常规方法》,药敏试验采用纸片扩散法(K-B法)测定菌株对抗菌药物的抑菌环直径,参照2016年版美国临床实验室标准化委员会标准进行结果判定,统计常用抗菌药物头孢他啶、头孢吡肟、哌拉西林他唑巴坦、左氧氟沙星、磺胺、亚胺培南、阿米卡星的耐药率。按照是否多次手术、采样前是否应用抗菌药物治疗、是否混合菌感染及是否合并糖尿病分为4组亚组并进一步分析与手术高度相关的耐药率增加的危险因素。结果 去除重复株后骨科创面感染1 319株阳性菌株中肺炎克雷伯菌共检出81株,占比6.14%。多次手术组(n=48)所分离出的肺炎克雷伯菌与单次手术组(n=33)相比,头孢他啶(χ^(2)=6.278,P=0.012)、头孢吡肟(χ^(2)=10.197,P=0.001)、哌拉西林他唑巴坦(χ^(2)=10.206,P=0.001)、左氧氟沙星(χ^(2)=9.857,P=0.002)、磺胺(χ^(2)=3.909,P=0.048)和亚胺培南(χ^(2)=4.753,P=0.029)耐药率明显较高,但两组阿米卡星耐药率差异无统计学意义(P>0.05)。应用抗菌药物组(n=63)所分离出的肺炎克雷伯菌与未应用抗菌药物组(n=18)相比,头孢他啶(χ^(2)=8.416,P=0.004)、头孢吡肟(χ^(2)=10.940,P=0.001)、左氧氟沙星(χ^(2)=9.051,P=0.003)和磺胺(χ^(2)=6.671,P=0.010)耐药率明显较高,但两组哌拉西林他唑巴坦、亚胺培南和阿米卡星耐药率差异无统计学意义(P>0.05)。混合感染组(n=36)所分离出的肺炎克雷伯菌与单纯感染组(n=45)相比,头孢他啶(χ^(2)=3.889,P=0.049)和头孢吡肟(χ^(2)=4.531,P=0.033)耐药率明显较高,但两组哌拉西林他唑巴坦、左氧氟沙星、磺胺、亚胺培南和阿米卡星耐药率差异无�Objective To analyze the current status of Klebsiella pneumoniae in orthopedic wound infections and the risk factors for the increase of drug resistance rate in Yichang city,aiming to guide clinical treatment.Methods A retrospective analysis of patients with Klebsiella pneumoniae infection in orthopedic wound admitted to Orthopaedics Department of Yichang City Central People's Hospital from January 2017 to June 2022 was conducted.Bacterial culture and strain identification were performed according to the routine methods of clinical microbiological examination.The disk diffusion method(K-B method) was used to determine the diameter of inhibitory ring of strains against antibacterial drugs,and the results were judged according to the standards of American Clinical Laboratory Standardization Committee(2016 edition).The drug resistance rates of commonly used antibacterial drugs ceftazidime,cefepime,piperacillin tazobactam,levofloxacin,sulfanilamide,imipenem,and amikacin were counted.The patients were divided into four groups and subgroups according to whether they had undergone multiple surgeries,whether they had applied antibacterial drugs before sampling,whether they had mixed bacterial infections,and whether they had diabetes,and then the risk factors of increased drug resistance rates that were highly related to surgery were further analyzed.Results After removing duplicate strains,a total of 81 strains of Klebsiella pneumoniae were detected among 1 319positive strains of orthopedic wound infection accounting for 6.14%.Compared with the single operation group(n=33),the drug resistance rates of ceftazidime(χ^(2) =6.278,P=0.012),cefepime(χ^(2) =10.197,P=0.001),piperacillin tazobactam(χ^(2) =10.206,P=0.001),levofloxacin(χ^(2)=9.857,P=0.002),sulfanilamide(χ^(2)=3.909,P=0.048) and imipenem(χ^(2)=4.753,P=0.029) of Klebsiella pneumoniae isolated from the multiple operation group(n=48) were significantly increased.However,there was no significant difference in amikacin resistance rates between the two groups(P>0.05

关 键 词：肺炎克雷伯菌 骨科创面 耐药性 危险因素 

分 类 号：R681.2[医药卫生—骨科学]