ICU耐碳青霉烯类肺炎克雷伯菌医院获得性肺炎危险因素分析

目的了解耐碳青霉烯类肺炎克雷伯菌(CRKP)医院获得性肺炎(HAP)的危险因素,以制订防控措施,降低医院感染的发生率。方法收集重庆某三甲医院重症医学科(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CRKP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CSKP对照组,进行单因素分析和多因素Logistic回归分析。结果单因素分析结果显示,CRKP HAP的危险因素有感染前抗菌药物使用≥7d、感染前使用碳青霉烯类抗菌药物、机械通气天数≥7d、急性生理与慢性健康评分(APACHEⅡ评分)等11项因素。多因素Logistic回归分析结果显示,感染前使用碳青霉烯类抗菌药物、机械通气天数≥7d、APACHEⅡ评分是CRKP HAP的独立危险因素。结论 CRKP HAP的独立危险因素为感染前使用碳青霉烯类抗菌药物、机械通气天数≥7d、APACHEⅡ评分。合理应用抗菌药物,减少机械通气,做好手卫生,是降低CRKP HAP发生率的有效措施。

Risk factors of hospital-acquired pneumonia due to Carbapenem-resistant Klebsiella pneumonia in the ICU

Objective To understand the risk factors of hospital-acquired pneumonia(HAP) due to Carbapenem-resistant Kleb-siella pneumonia (CRKP) ,and propose prevention and control measures to reduce the incidence of hospital infection rate .Methods A total of Klebsiella pneumonia infection 73 patients with HAP ,who were treated in the ICU of a tertiary hospital in Chongqing from January 2014 to March 2016 were included .The 27 cases with CRKP were assigned as case group ,46 cases with Carbapenem-susceptible Klebsiella pneumonia(CSKP) were included as control group .Univariate and the multivariate Logistic regression analy-sis was performed for the risk factors .Results Univariate analysis showed that ,before infection ,the use of antimicrobial agents≥7 days ,Carbopenems ,mechanical ventilation ≥7 days ,APACHE Ⅱ score ,and at least 11 factors were the risk factors for CRKP HAP .Multivariate Logistic regression analysis showed that ,Carbapenems ,and mechanical ventilation≥7 days before infection and APACHE Ⅱ score was an independent risk factor of CRKP HAP .Conclusion Carbapenems ,and mechanical ventilation≥7 days before infection and APACHE Ⅱ score are the independent risk factors for CRKP HAP .Rational use of antibiotics ,reducing me-chanical ventilation and doing good hand hygiene are effective measures to reduce the incidence of CRKP HAP .