ICU中耐碳青霉烯类肺炎克雷伯杆菌感染患者耐药及预后的相关因素分析

发布时间：2018-01-12 21:20

本文关键词：ICU中耐碳青霉烯类肺炎克雷伯杆菌感染患者耐药及预后的相关因素分析　出处：《浙江大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的分析ICU中导致耐碳青霉烯类肺炎克雷伯杆菌感染患者耐药及影响预后的相关因素,为细菌耐药的防治提供临床参考。方法收集ICU经细菌培养鉴定为肺炎克雷伯杆菌的菌株230株,分析培养标本来源分布。将190例ICU肺炎克雷伯杆菌感染患者按药敏试验结果分为耐碳青霉烯类组和非耐碳青霉烯类组,收集每例患者临床情况、抗菌素使用情况及预后等因素,分析其与耐碳青霉烯类肺炎克雷伯杆菌产生的相关性,并对2组患者的病死率及影响病死率的相关因素进行分析。结果本研究从190例患者中共分离到230个肺炎克雷伯杆菌菌株,从痰中分离的菌株占首位(60%)。2009-2011年三年间耐药率呈逐年升高的趋势。肺炎克雷伯杆菌耐药的产生与感染部位的个数、碳青霉烯类抗菌素的使用罾切相关。耐碳青霉烯类组病死率46.90%,非耐碳青霉烯类组病死率33.77%,2组患者病死率在统计学上无显著差别。在本研究中,患者患有多脏器功能障碍综合症(MODS)、恶性肿瘤及急性生理与慢性健康状况评估系统(APACHE)II评分、喹诺酮类抗菌素的使用与病死率密切相关。结论目前耐碳青霉烯类肺炎克雷伯杆菌感染的比例有逐年升高的趋势,细菌耐药的产生是多方面的因素,既与机体感染部位数量有关,更与抗菌素的暴露相关。影响感染患者最终转归的因素也是多方面的,本研究中虽然无法证明耐药与病死率的直接关系,但可以证实患者的基础疾病情况与APACHE Ⅱ评分与患者的转归有直接关系,同时本研究发现喹诺酮类抗菌素的暴露与感染患者的转归相关。
[Abstract]:Objective to analyze the ICU cause of carbapenem resistant Klebsiella pneumoniae resistance and influence factors related to prognosis of infection with Klebsiella pneumoniae, and provide clinical reference for the prevention and control of bacterial resistance. Methods ICU the bacterial culture was identified as Klebsiella pneumoniae 230 strains, analysis of the training samples. The distribution of 190 cases of Klebsiella pneumoniae ICU Klebsiella pneumoniae infection patients according to the results of drug sensitive test for carbapenem resistant group and non carbapenem resistant group were collected from every patients, factors of antibiotic use and the prognosis, and the correlation analysis of carbapenem resistant Klebsiella pneumoniae Klebsiella bacillus, and related factors for mortality and the influence of the 2 groups of patients with the mortality rate were analyzed. The results from 190 patients with isolated 230 strains of Klebsiella pneumoniae strains, isolated from sputum accounted for the first (60%) in the three years.2009-2011 resistance rate was Increased year by year. The number and site of infection, Klebsiella pneumoniae resistant to the carbapenem antibiotic use. Zeng is closely related to the carbapenem resistant group the mortality rate was 46.90%, non carbapenem resistant group, the mortality rate was 33.77%, the mortality rate of 2 groups of patients had no significant difference in statistics. In this study, patients with multiple organ dysfunction syndrome (MODS), the evaluation system of malignant tumor and acute physiology and chronic health evaluation (APACHE) II, the use of quinolones and mortality rate are closely related. Conclusion the carbapenem resistant Klebsiella pneumoniae infection ratio increased year by year, bacteria the resistance factors in many aspects, not only related to the number and the site of infection, more related to antibiotic exposure. Factors affecting the final outcome of the patients with infection is also in many aspects, in this study, although no proof of resistance It is directly related to the fatality rate, but it can be confirmed that the basic disease of patients is directly related to the APACHE II score and the outcome of patients. Meanwhile, it is found that the exposure of quinolone antibiotics is related to the outcome of infected patients.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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