發(fā)布時間：2018-08-30 17:51

【摘要】：目的:分析重癥監(jiān)護病房(ICU)中肺炎克雷伯菌感染的醫(yī)院獲得性肺炎(HAP)患者對碳青霉烯類抗菌藥物耐藥的危險因素以及預后的影響因素,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例對碳青霉烯類敏感的肺炎克雷伯菌(CSKP)感染者為對照組,進行單因素分析和Logistic回歸多因素分析,并對兩組結(jié)局指標進行分析。根據(jù)73例病人的預后將其分為死亡組(21例)和好轉(zhuǎn)/治愈組(52例),應用上述方法進行預后影響因素分析。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、機械通氣時間≥7天、APACHE II評分是肺炎克雷伯菌對碳青霉烯類抗菌藥物耐藥的危險因素;Logistic回歸多因素分析顯示感染前使用碳青霉烯類抗生素、機械通氣天數(shù)≥7天、APACHE II評分是肺炎克雷伯菌對碳青霉烯類抗菌藥物耐藥的獨立危險因素。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)局差異無統(tǒng)計學意義(χ2=0.436,P=0.5091)。73例HAP患者預后單因素分析結(jié)果顯示使用碳青霉烯類抗菌藥物、APACHE II評分是患者死亡的危險因素;Logistic回歸多因素分析顯示APACHE II評分是患者死亡的獨立危險因素。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、長時間機械通氣、APACHE II評分高的病人更易導致肺炎克雷伯菌對碳青霉烯類耐藥;APACHE II評分高的病人其死亡率越高。因此,臨床工作需注意合理應用抗菌藥物,減少病人的侵入性操作,嚴格執(zhí)行醫(yī)院感染的防控措施,改善病人的預后。
[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：2213822