【摘要】：目的:分析重癥監(jiān)護(hù)病房(ICU)中肺炎克雷伯菌感染的醫(yī)院獲得性肺炎(HAP)患者對(duì)碳青霉烯類抗菌藥物耐藥的危險(xiǎn)因素以及預(yù)后的影響因素,制定防控措施,降低耐碳青霉烯類肺炎克雷伯菌(CRKP)感染的發(fā)生率,改善病人的預(yù)后。方法:收集重慶某三甲醫(yī)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感染者為觀察組,46例對(duì)碳青霉烯類敏感的肺炎克雷伯菌(CSKP)感染者為對(duì)照組,進(jìn)行單因素分析和Logistic回歸多因素分析,并對(duì)兩組結(jié)局指標(biāo)進(jìn)行分析。根據(jù)73例病人的預(yù)后將其分為死亡組(21例)和好轉(zhuǎn)/治愈組(52例),應(yīng)用上述方法進(jìn)行預(yù)后影響因素分析。結(jié)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)。單因素分析結(jié)果顯示:糖尿病、慢性肺病、腎功能不全、感染前ICU住院天數(shù)、抗菌藥物使用≥7d、二聯(lián)用藥、三聯(lián)及以上用藥、酶抑制劑、碳青霉烯類、機(jī)械通氣時(shí)間≥7天、APACHE II評(píng)分是肺炎克雷伯菌對(duì)碳青霉烯類抗菌藥物耐藥的危險(xiǎn)因素;Logistic回歸多因素分析顯示感染前使用碳青霉烯類抗生素、機(jī)械通氣天數(shù)≥7天、APACHE II評(píng)分是肺炎克雷伯菌對(duì)碳青霉烯類抗菌藥物耐藥的獨(dú)立危險(xiǎn)因素。2.73例感染肺炎克雷伯菌的HAP患者總體死亡率28.77%(21/73),CRKP組死亡率為26.09%(12/46),CSKP組死亡率為33.33%(9/27),兩組結(jié)局差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.436,P=0.5091)。73例HAP患者預(yù)后單因素分析結(jié)果顯示使用碳青霉烯類抗菌藥物、APACHE II評(píng)分是患者死亡的危險(xiǎn)因素;Logistic回歸多因素分析顯示APACHE II評(píng)分是患者死亡的獨(dú)立危險(xiǎn)因素。結(jié)論:ICU肺炎克雷伯菌感染的HAP患者中,使用碳青霉烯類抗生素、長(zhǎng)時(shí)間機(jī)械通氣、APACHE II評(píng)分高的病人更易導(dǎo)致肺炎克雷伯菌對(duì)碳青霉烯類耐藥;APACHE II評(píng)分高的病人其死亡率越高。因此,臨床工作需注意合理應(yīng)用抗菌藥物,減少病人的侵入性操作,嚴(yán)格執(zhí)行醫(yī)院感染的防控措施,改善病人的預(yù)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，

本文編號(hào)：2213822