【摘要】：目的：研究ICU內(nèi)不同部位感染的肺炎克雷伯菌的耐藥性及耐碳青霉烯類抗生素菌株感染的危險因素。方法：回顧性分析本院ICU內(nèi)2012年1月至2013年12月不同部位培養(yǎng)分離出的共173株肺炎克雷伯菌的流行病學(xué)資料,不同部位的菌株分別按其對碳青霉烯類抗生素耐藥情況分為對碳青霉烯類耐藥組與敏感組,比較兩組的耐藥性及預(yù)后；并分別以敏感組為對照組,分析耐碳青霉烯類抗生素的肺炎克雷伯菌感染的危險因素。結(jié)果：173株肺炎克雷伯菌中,來自血液感染的有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,創(chuàng)面感染的有4株；173株肺炎克雷伯菌中對碳青霉烯類耐藥的有78株,耐藥率達45.09%； 48株血液感染的肺炎克雷伯菌中有29株對碳青霉烯類抗生素耐藥,耐藥率達60.42%,91株痰液中分離的肺炎克雷伯菌中有34株對碳青霉烯類抗生素耐藥,耐藥率達37.62%；12株尿液中分離的肺炎克雷伯菌中有6株對碳青霉烯類抗生素耐藥,耐藥率達50%；18株腹腔引流液中分離的肺炎克雷伯菌有7株對碳青霉烯類耐藥,耐藥率達38.89%；4株分泌物中分離的肺炎克雷伯菌對碳青霉烯類抗生素耐藥的有2株,耐藥率達50%；因尿路感染、腹腔感染及創(chuàng)面感染的病例樣本量較少,故本研究中暫只對血液感染組和肺部感染組進行下一步耐藥性、預(yù)后及危險因素分析；在耐藥性的分析中血液中和痰液中分離出肺炎克雷伯菌結(jié)果大致相同,即除了氨芐西林和復(fù)方新諾明外,耐碳青霉烯類組細菌對測試抗生素的耐藥率明顯高于敏感組,但耐碳青霉烯組與敏感組的死亡率、細菌清除率、7天生存率和28天生存率并無明顯差別,兩者間比較無統(tǒng)計學(xué)意義；經(jīng)單因素和多因素的Logistic回歸分析顯示在所分析的相關(guān)危險因素中耐碳青霉烯類肺炎克雷伯菌血液感染的獨立危險因素為深靜脈置管的置入(OR=22.823)和碳青霉烯類抗生素的暴露(OR=7.943),而肺部感染的獨立危險因素為年齡≥65歲(OR=3.749)、使用頭孢菌素類抗生素(OR=4.276)和使用碳青霉烯類抗生素(OR=8.435)。結(jié)論：ICU內(nèi)肺炎克雷伯菌對碳青酶烯類抗生素耐藥率較高；深靜脈置管的置入和碳青霉烯類抗生素的暴露是耐碳青霉烯類肺炎克雷伯菌血液感染的獨立危險因素；年齡≥65歲、使用頭孢菌素類抗生素和使用碳青霉烯類抗生素是耐碳青霉烯類肺炎克雷伯菌肺部感染的獨立危險因素。
[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，

本文編號：2250259