Background： Klebsiellapneumoniae （KP） is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP （CRKP） is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP （CSKP） ...Background： Klebsiellapneumoniae （KP） is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP （CRKP） is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP （CSKP） isolates. The aim of the present study was to identify the risk factors for CRKP infection and the predictors of mortality among KP-infected adult patients. Methods： Patients with CRKP and CSKP infection were categorized as the case group and control group, respectively, and we conducted a 1：1 ratio case-control study on these groups. The CRKP isolates collected were tested tbr antimicrobial susceptibility and presence of KP carbapenemase （KPC） gene. Clinical data were collected to identity risk factors for CRKP infection and mortality of KP infection. Risk factors were analyzed under univariable and multivariable logistic regression model. Results： The independent risk factors for CRKP infection were admission to Intensive Care Unit （odds ratio [OR]： 15.486, 95% confidence interval [CI]： 3.175-75.541, P 〈 0.001）; use of I3-1actams and [3-1actamase inhibitor combination （OR： 4.765, 95% CI： 1.508-15.055, P = 0.008）： use of cephalosporins （OR： 8.033, 95% CI： 1.623-39.763, P = P= 0.019）： and indwelling of urethral catheter （OR： 6.164, 95% CI： 1.847 0.011 ）; fluoroquinolones （OR： 6.090, 95% CI： 1.343-27.613, -20.578, P = 0.003）. However, older age （OR： 1.079, 95% CI： 1.005-1.158, P= 0.036）, Charlson comorbidity index （OR： 4.690, 95% CI：2.094-10.504, P= 0.000）, and aminoglycoside use （OR： 670.252, 95% CI： 6.577-68,307.730, P = 0.006） were identified as independent risk factors for patient deaths with KP infection. The mortality of CRKP group was higher than that of the CSKP group. KPC gene did not play a role in the CRKP group. CRKP mortality was high. Conclusion： Implementation of infection control measures and protection of the immunefunction are crucial.展开更多
为了对兰州市榆中县某奶牛场犊牛疑似肺炎克雷伯氏菌感染病例进行确诊,本研究采集病死犊牛的脏器组织并从中分离到1株革兰阴性短杆菌,进而对分离菌进行了生化鉴定、16S r RN A鉴定及khe基因鉴定,在此基础上,完成了分离菌的致病性试验、...为了对兰州市榆中县某奶牛场犊牛疑似肺炎克雷伯氏菌感染病例进行确诊,本研究采集病死犊牛的脏器组织并从中分离到1株革兰阴性短杆菌,进而对分离菌进行了生化鉴定、16S r RN A鉴定及khe基因鉴定,在此基础上,完成了分离菌的致病性试验、耐药性分析及主要毒力基因的遗传进化分析。结果显示,除H2S试验外,分离菌生化特性均符合肺炎克雷伯氏菌的生化反应特性,其16S r RNA及khe基因序列与G enB ank中肺炎克雷伯氏菌株之间的同源性均高达99%,因此,可将分离菌确定为肺炎克雷伯氏菌,并将其命名为YZ2015。动物试验及耐药性试验结果表明,分离菌具有较强的致病性和多重耐药性。遗传进化分析表明,分离菌的fim H、mrk D及wab G基因与肺炎克雷伯氏菌其他菌株具有很高的同源性,其核酸序列相似性高达95%以上。展开更多
基金This work was supported by the National Natural Science Foundation of China under Grant （No. 81201338）.
文摘Background： Klebsiellapneumoniae （KP） is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP （CRKP） is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP （CSKP） isolates. The aim of the present study was to identify the risk factors for CRKP infection and the predictors of mortality among KP-infected adult patients. Methods： Patients with CRKP and CSKP infection were categorized as the case group and control group, respectively, and we conducted a 1：1 ratio case-control study on these groups. The CRKP isolates collected were tested tbr antimicrobial susceptibility and presence of KP carbapenemase （KPC） gene. Clinical data were collected to identity risk factors for CRKP infection and mortality of KP infection. Risk factors were analyzed under univariable and multivariable logistic regression model. Results： The independent risk factors for CRKP infection were admission to Intensive Care Unit （odds ratio [OR]： 15.486, 95% confidence interval [CI]： 3.175-75.541, P 〈 0.001）; use of I3-1actams and [3-1actamase inhibitor combination （OR： 4.765, 95% CI： 1.508-15.055, P = 0.008）： use of cephalosporins （OR： 8.033, 95% CI： 1.623-39.763, P = P= 0.019）： and indwelling of urethral catheter （OR： 6.164, 95% CI： 1.847 0.011 ）; fluoroquinolones （OR： 6.090, 95% CI： 1.343-27.613, -20.578, P = 0.003）. However, older age （OR： 1.079, 95% CI： 1.005-1.158, P= 0.036）, Charlson comorbidity index （OR： 4.690, 95% CI：2.094-10.504, P= 0.000）, and aminoglycoside use （OR： 670.252, 95% CI： 6.577-68,307.730, P = 0.006） were identified as independent risk factors for patient deaths with KP infection. The mortality of CRKP group was higher than that of the CSKP group. KPC gene did not play a role in the CRKP group. CRKP mortality was high. Conclusion： Implementation of infection control measures and protection of the immunefunction are crucial.
