ICU中CRKP感染的医院获得性肺炎患者耐药及预后的危险因素分析
发布时间：2018-08-30 17:51
【摘要】：目的:分析重症监护病房(ICU)中肺炎克雷伯菌感染的医院获得性肺炎(HAP)患者对碳青霉烯类抗菌药物耐药的危险因素以及预后的影响因素,制定防控措施,降低耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的发生率,改善病人的预后。方法:收集重庆某三甲医院ICU 2014年1月至2016年3月肺炎克雷伯菌感染的HAP患者73例,以27例CRKP感染者为观察组,46例对碳青霉烯类敏感的肺炎克雷伯菌(CSKP)感染者为对照组,进行单因素分析和Logistic回归多因素分析,并对两组结局指标进行分析。根据73例病人的预后将其分为死亡组(21例)和好转/治愈组(52例),应用上述方法进行预后影响因素分析。结果:1.73例感染肺炎克雷伯菌的HAP患者中,CRKP感染者占36.99%(27/73),CSKP感染者占63.01%(46/73)。单因素分析结果显示:糖尿病、慢性肺病、肾功能不全、感染前ICU住院天数、抗菌药物使用≥7d、二联用药、三联及以上用药、酶抑制剂、碳青霉烯类、机械通气时间≥7天、APACHE II评分是肺炎克雷伯菌对碳青霉烯类抗菌药物耐药的危险因素;Logistic回归多因素分析显示感染前使用碳青霉烯类抗生素、机械通气天数≥7天、APACHE II评分是肺炎克雷伯菌对碳青霉烯类抗菌药物耐药的独立危险因素。2.73例感染肺炎克雷伯菌的HAP患者总体死亡率28.77%(21/73),CRKP组死亡率为26.09%(12/46),CSKP组死亡率为33.33%(9/27),两组结局差异无统计学意义(χ2=0.436,P=0.5091)。73例HAP患者预后单因素分析结果显示使用碳青霉烯类抗菌药物、APACHE II评分是患者死亡的危险因素;Logistic回归多因素分析显示APACHE II评分是患者死亡的独立危险因素。结论:ICU肺炎克雷伯菌感染的HAP患者中,使用碳青霉烯类抗生素、长时间机械通气、APACHE II评分高的病人更易导致肺炎克雷伯菌对碳青霉烯类耐药;APACHE II评分高的病人其死亡率越高。因此,临床工作需注意合理应用抗菌药物,减少病人的侵入性操作,严格执行医院感染的防控措施,改善病人的预后。
[Abstract]:Objective: to analyze the risk factors and prognostic factors of carbapenem antibiotic resistance in nosocomial pneumonia (HAP) patients infected with Klebsiella pneumoniae in intensive care unit (ICU). To reduce the incidence of Klebsiella pneumoniae (CRKP) infection and improve the prognosis of patients. Methods: 73 HAP patients infected with Klebsiella pneumoniae from January 2014 to March 2016 in a third Class A Hospital in Chongqing were collected, and 46 cases of (CSKP) infected with Klebsiella pneumoniae sensitive to carbapenem were selected as control group. Univariate analysis and Logistic regression multivariate analysis were performed. According to the prognosis of 73 patients, they were divided into death group (21 cases) and improvement / cure group (52 cases). Results among 1.73 HAP patients infected with Klebsiella pneumoniae, 36.99% (27 / 73) were infected with HAP and 63.01% (46 / 73) were infected with HAP. Univariate analysis showed that: diabetes mellitus, chronic pulmonary disease, renal insufficiency, ICU hospitalization days before infection, antimicrobial drug use 鈮，
本文编号：2213822
[Abstract]:Objective: to analyze the risk factors and prognostic factors of carbapenem antibiotic resistance in nosocomial pneumonia (HAP) patients infected with Klebsiella pneumoniae in intensive care unit (ICU). To reduce the incidence of Klebsiella pneumoniae (CRKP) infection and improve the prognosis of patients. Methods: 73 HAP patients infected with Klebsiella pneumoniae from January 2014 to March 2016 in a third Class A Hospital in Chongqing were collected, and 46 cases of (CSKP) infected with Klebsiella pneumoniae sensitive to carbapenem were selected as control group. Univariate analysis and Logistic regression multivariate analysis were performed. According to the prognosis of 73 patients, they were divided into death group (21 cases) and improvement / cure group (52 cases). Results among 1.73 HAP patients infected with Klebsiella pneumoniae, 36.99% (27 / 73) were infected with HAP and 63.01% (46 / 73) were infected with HAP. Univariate analysis showed that: diabetes mellitus, chronic pulmonary disease, renal insufficiency, ICU hospitalization days before infection, antimicrobial drug use 鈮，
本文编号：2213822
本文链接：https://www.wllwen.com/yixuelunwen/huxijib/2213822.html
最近更新
教材专著
