摘要
目的 分析耐碳青霉烯类肺炎克雷伯菌(carbapene-resistant Klebsiella pneumoniae, CRKP)感染临床特征及危险因素,为临床有效防控CRKP感染提供科学依据。方法 选取兰州大学第一医院2020年1月—2021年12月检出肺炎克雷伯菌的住院患者作为研究对象,采用回顾性病例-对照研究方法,选取该时段检出CRKP的住院患者113例作为CRKP组,同期检出碳青霉烯类敏感肺炎克雷伯菌(carbapenem-susceptible Klebsiella pneumoniae, CSKP)的住院患者113例作为CSKP组,收集两组患者临床资料,采用单因素分析和二元Logistic回归分析方法,分析CRKP感染的危险因素。结果 CRKP菌株的耐药率均高于CSKP菌株的耐药率;113株CRKP对甲氧苄啶/磺胺甲恶唑和阿米卡星耐药率相对稍低(70.80%和75.22%);对氨曲南、庆大霉素、左氧氟沙星和四环素的耐药率分别为99.12%、84.96%、87.61%和87.61%,对其余抗菌药物的耐药率均高达100%;二元Logistic回归分析显示,神经系统疾病、低白蛋白血症、有创呼吸机辅助通气、有创呼吸机辅助通气天数、免疫抑制剂使用史、感染前联合使用抗菌药物为CRKP感染的独立危险因素,而激素使用史是CRKP感染的保护因素(P<0.05)。结论 CRKP对临床常用抗菌药物呈高度耐药,耐药形势严峻。研究分析CRKP感染的危险因素,针对性采取防控措施,从而减少CRKP感染的发生。
Objective To analyze the clinical characteristics and risk factors of carbapenem-resistant Klebsiella pneumoniae(CRKP)infection and to provide evidence for effective prevention and control of CRKP infection.Methods The inpatients detected with Klebsiella pneumoniae in the First Hospital of Lanzhou University from January 2020 to December 2021 were selected as the research objects.A retrospective case-control study was conducted to select 113 inpatients detected with CRKP during this period as the CRKP group and 113 inpatients detected with carbapenem-susceptible Klebsiella pneumoniae(CSKP)during the same period as the CSKP group.The clinical data of the two groups were collected.Univariate analysis and binary logistic regression analysis were used to analyze the risk factors for CRKP infection.Results The resistance rates of CRKP strains were all higher than those of CSKP strains.The resistance rates of 113 CRKP strains to trimethoprim/sulfamethoxazole and amikacin were relatively low(70.80%and 75.22%).The resistance rates to aztreonam,gentamicin,levofloxacin and tetracycline were 99.12%,84.96%,87.61%and 87.61%,respectively,and the resistance rates to the rest of antibiotics were as high as 100.00%.Binary logistic regression analysis showed that neurological diseases,hypoalbuminemia,invasive ventilator-assisted ventilation,days of invasive ventilator-assisted ventilation,use of immunosuppressive agents,and combined use of antibiotics before infection were independent risk factors for CRKP infection,while the use of hormones was a protective factor for CRKP infection(P<0.05).Conclusion CRKP is highly resistant to commonly used clinical antimicrobial drugs,and the drug resistance situation is grim.To study and analyze the risk factors of CRKP infection and take targeted prevention and control measures to reduce the occurrence of CRKP infection.
作者
张甜甜
刘志武
黄喜凤
陈琳
Zhang Tiantian;Liu Zhiwu;Huang Xifeng;Chen Lin(The First Clinical Medical College of Lanzhou University,Lanzhou 730000;Department of Clinical Medical Laboratory,the First Hospital of Lanzhou University,Lanzhou 730000;Lanzhou Pulmonary Hospital,Lanzhou 730046;Department of Infectious Diseases,First Hospital of Lanzhou University,Lanzhou 730000)
出处
《中国抗生素杂志》
CAS
CSCD
北大核心
2024年第2期208-214,共7页
Chinese Journal of Antibiotics
基金
甘肃省自然科学基金资助项目(No.21JR1RA082)
兰州市科技计划项目(No.2021-1-121)。
关键词
医院感染
耐碳青霉烯类肺炎克雷伯菌
耐药性
危险因素
Hospital infection
Carbapene-resistant Klebsiella pneumoniae
Drug resistance
Risk factors
