ICU内不同部位肺炎克雷伯菌的耐药性及耐碳青霉烯类抗生素菌株感染的危险因素分析

发布时间：2018-09-19 13:26

【摘要】：目的：研究ICU内不同部位感染的肺炎克雷伯菌的耐药性及耐碳青霉烯类抗生素菌株感染的危险因素。方法：回顾性分析本院ICU内2012年1月至2013年12月不同部位培养分离出的共173株肺炎克雷伯菌的流行病学资料,不同部位的菌株分别按其对碳青霉烯类抗生素耐药情况分为对碳青霉烯类耐药组与敏感组,比较两组的耐药性及预后；并分别以敏感组为对照组,分析耐碳青霉烯类抗生素的肺炎克雷伯菌感染的危险因素。结果：173株肺炎克雷伯菌中,来自血液感染的有48株,肺部感染的有91株,尿路感染的有12株,腹腔感染的有18株,创面感染的有4株；173株肺炎克雷伯菌中对碳青霉烯类耐药的有78株,耐药率达45.09%； 48株血液感染的肺炎克雷伯菌中有29株对碳青霉烯类抗生素耐药,耐药率达60.42%,91株痰液中分离的肺炎克雷伯菌中有34株对碳青霉烯类抗生素耐药,耐药率达37.62%；12株尿液中分离的肺炎克雷伯菌中有6株对碳青霉烯类抗生素耐药,耐药率达50%；18株腹腔引流液中分离的肺炎克雷伯菌有7株对碳青霉烯类耐药,耐药率达38.89%；4株分泌物中分离的肺炎克雷伯菌对碳青霉烯类抗生素耐药的有2株,耐药率达50%；因尿路感染、腹腔感染及创面感染的病例样本量较少,故本研究中暂只对血液感染组和肺部感染组进行下一步耐药性、预后及危险因素分析；在耐药性的分析中血液中和痰液中分离出肺炎克雷伯菌结果大致相同,即除了氨苄西林和复方新诺明外,耐碳青霉烯类组细菌对测试抗生素的耐药率明显高于敏感组,但耐碳青霉烯组与敏感组的死亡率、细菌清除率、7天生存率和28天生存率并无明显差别,两者间比较无统计学意义；经单因素和多因素的Logistic回归分析显示在所分析的相关危险因素中耐碳青霉烯类肺炎克雷伯菌血液感染的独立危险因素为深静脉置管的置入(OR=22.823)和碳青霉烯类抗生素的暴露(OR=7.943),而肺部感染的独立危险因素为年龄≥65岁(OR=3.749)、使用头孢菌素类抗生素(OR=4.276)和使用碳青霉烯类抗生素(OR=8.435)。结论：ICU内肺炎克雷伯菌对碳青酶烯类抗生素耐药率较高；深静脉置管的置入和碳青霉烯类抗生素的暴露是耐碳青霉烯类肺炎克雷伯菌血液感染的独立危险因素；年龄≥65岁、使用头孢菌素类抗生素和使用碳青霉烯类抗生素是耐碳青霉烯类肺炎克雷伯菌肺部感染的独立危险因素。
[Abstract]:Aim: to study the drug resistance of Klebsiella pneumoniae infected in different parts of ICU and the risk factors of carbapene-resistant antibiotics. Methods: the epidemiological data of 173 strains of Klebsiella pneumoniae isolated from ICU from January 2012 to December 2013 were analyzed retrospectively. According to their resistance to carbapenem antibiotics, strains in different parts were divided into carbapenem resistance group and sensitive group, and the drug resistance and prognosis of the two groups were compared, and the sensitive group was taken as the control group. To analyze the risk factors of Klebsiella pneumoniae infection resistant to carbapenem antibiotics. Results among 173 strains of Klebsiella pneumoniae, 48 were from blood, 91 from lung, 12 from urinary tract, 18 from abdominal cavity and 4 from wound. Among 173 strains of Klebsiella pneumoniae, 78 strains were resistant to carbapenem, the resistance rate was 45.09, and 29 of 48 strains of Klebsiella pneumoniae were resistant to carbapenem antibiotics. 34 strains of Klebsiella pneumoniae isolated from sputum were resistant to carbapenem antibiotics and 6 of 12 strains of Klebsiella pneumoniae isolated from urine were resistant to carbapenem antibiotics. Of the 18 strains of Klebsiella pneumoniae isolated from peritoneal drainage fluid, 7 strains were resistant to carbapenem, and 2 strains of Klebsiella pneumoniae isolated from the secretions of 38.89% were resistant to carbapenem antibiotics, and the resistance rate was 50%. Because of the small sample size of urinary tract infection, abdominal infection and wound infection, the next step drug resistance, prognosis and risk factors were analyzed only in blood infection group and pulmonary infection group. In drug resistance analysis, Klebsiella pneumoniae isolated from blood and sputum were approximately the same, that is, except ampicillin and compound sulfamine, the resistance rate of carbapenem group to test antibiotics was significantly higher than that of sensitive group. However, there was no significant difference between carbapenem tolerant group and sensitive group in mortality, bacterial clearance rate, 7 day survival rate and 28 day survival rate, but there was no significant difference between the two groups. Univariate and multivariate Logistic regression analysis showed that the independent risk factors for blood infection of Klebsiella pneumoniae were deep vein catheterization (OR=22.823) and carbapenem antibiotics. The independent risk factors for pulmonary infection were age 鈮，

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