耐碳青霉烯类抗生素肺炎克雷伯菌呼吸机相关性肺炎的危险因素

发布时间：2018-07-05 19:16

  本文选题：肺炎克雷伯菌 + 碳青霉烯类耐药　； 参考：《中国老年学杂志》2014年21期

【摘要】：目的了解重症医学科(ICU)临床分离的耐碳青霉烯类抗生素的肺炎克雷伯菌(CRKP)所致的呼吸机相关性肺炎(VAP)的流行病学及耐药情况,并探讨ICU中CRKP所致的VAP的危险因素。方法选择2011年7月至2013年7月入住该院ICU肺炎克雷伯菌感染的患者,通过测定肺炎克雷伯菌对常用抗菌药物的敏感性,对CRKP和碳青霉烯类抗生素敏感的肺炎克雷伯菌(CSKP)的VAP患者进行1∶1回顾性病例对照研究。结果 1ICU中CRKP所致的VAP的独立危险因素是分离出病原菌前14 d内接受广谱抗生素治疗≥7 d(尤其是应用碳青霉烯类抗生素OR=3.28、β-内酰胺酶抑制剂类抗生素OR=1.97、三代或四代头孢菌素OR=2.92、喹诺酮类抗生素OR=2.42)、机械通气时间≥7 d(OR=2.85)。2CRKP组菌株除了对亚胺培南耐药外,对β-内酰胺类、三代或四代头孢菌素及氟喹诺酮类抗生素的耐药率均为100%,仅对替加环素、阿米卡星及庆大霉素保持一定敏感性,优于其他抗生素。结论优化广谱抗生素或联合抗生素的使用、缩短广谱抗生素及联合抗生素的使用时间,尽快实施目标治疗以及尽可能缩短机械通气时间或许能够有效避免ICU内CRKP相关VAP的发生,重在预防。
[Abstract]:Objective to investigate the epidemiology and drug resistance of ventilator associated pneumonia (VAP) caused by Klebsiella pneumoniae (CRKP) isolated from ICU and explore the risk factors of VAP induced by CRKP in ICU. Methods patients with Klebsiella pneumoniae infection in ICU from July 2011 to July 2013 were selected and the sensitivity of Klebsiella pneumoniae to common antibiotics was determined. A 1:1 retrospective case-control study was conducted in VAP patients with CRKP and carbapenem antibiotic sensitive Klebsiella pneumoniae (CSKP). Results 1the independent risk factor of VAP induced by CRKP in ICU was that the pathogen was treated with broad-spectrum antibiotics for more than 7 days within 14 days before isolation (especially with carbapenem antibiotics OR3.28, 尾 -lactamases inhibitor antibiotics OR1.97, third generation or fourth generation). In addition to resistance to imipenem, the strains in the group of cephalosporin OR2.92, quinolones antibiotic OR2.42) and mechanical ventilation time 鈮，

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