本文選題：肺炎克雷伯菌 + 碳青霉烯類耐藥��； 參考：《中國老年學(xué)雜志》2014年21期

【摘要】：目的了解重癥醫(yī)學(xué)科(ICU)臨床分離的耐碳青霉烯類抗生素的肺炎克雷伯菌(CRKP)所致的呼吸機(jī)相關(guān)性肺炎(VAP)的流行病學(xué)及耐藥情況,并探討ICU中CRKP所致的VAP的危險(xiǎn)因素。方法選擇2011年7月至2013年7月入住該院ICU肺炎克雷伯菌感染的患者,通過測定肺炎克雷伯菌對(duì)常用抗菌藥物的敏感性,對(duì)CRKP和碳青霉烯類抗生素敏感的肺炎克雷伯菌(CSKP)的VAP患者進(jìn)行1∶1回顧性病例對(duì)照研究。結(jié)果 1ICU中CRKP所致的VAP的獨(dú)立危險(xiǎn)因素是分離出病原菌前14 d內(nèi)接受廣譜抗生素治療≥7 d(尤其是應(yīng)用碳青霉烯類抗生素OR=3.28、β-內(nèi)酰胺酶抑制劑類抗生素OR=1.97、三代或四代頭孢菌素OR=2.92、喹諾酮類抗生素OR=2.42)、機(jī)械通氣時(shí)間≥7 d(OR=2.85)。2CRKP組菌株除了對(duì)亞胺培南耐藥外,對(duì)β-內(nèi)酰胺類、三代或四代頭孢菌素及氟喹諾酮類抗生素的耐藥率均為100%,僅對(duì)替加環(huán)素、阿米卡星及慶大霉素保持一定敏感性,優(yōu)于其他抗生素。結(jié)論優(yōu)化廣譜抗生素或聯(lián)合抗生素的使用、縮短廣譜抗生素及聯(lián)合抗生素的使用時(shí)間,盡快實(shí)施目標(biāo)治療以及盡可能縮短機(jī)械通氣時(shí)間或許能夠有效避免ICU內(nèi)CRKP相關(guān)VAP的發(fā)生,重在預(yù)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，

本文編號(hào)：2101443