2014~2018年我院耐碳青霉烯类肺炎克雷伯菌分布特点及感染患者的临床特点

目的 调查某三甲医院近5年耐碳青霉烯类肺炎克雷伯菌的检出情况、感染患者的临床特点，为临床诊疗提供依据。方法收集2014年1月~2018年12月该院临床分离的肺炎克雷伯菌菌株，分析耐碳青霉烯类肺炎克雷伯菌检出率、标本来源分布、科室分布、耐药情况及预后因素。结果 共检出耐碳青霉烯类肺炎克雷伯菌690株，检出率为14.29%；2018年耐碳青霉烯类肺炎克雷伯菌检出率高于2014~2016年，差异有统计学意义（P＜0.05）；标本来源前5位分别为痰、中段尿、血、切口分泌物、导管，标本科室前5位分别是ICU、呼吸科、泌尿外科、烧伤科、神经外科。16种抗生素药敏检测中，CRKP对15种抗生素耐药率超过50%，耐碳青霉烯类肺炎克雷伯菌对复方新明、米诺环素、替加环素、多粘菌素耐药率相对较低，分别为46.91%、31.86%、10.73%、10.10%。治疗无效患者及治疗有效患者在合并基础病≥3种、患有糖尿病、患有恶性肿瘤、入住ICU、机械通气、保留导尿、其他侵袭性操作、混合感染间比较，差异有统计学意义（P＜0.05）；治疗无效患者及治疗有效患者在性别、吸烟、饮酒、心血管疾病、神经系统疾病、血液病、慢性肺病、慢性肝肾功能不全、近期大手术、既往多次住院或本次就诊前已住院间比较，差异无统计学意义（P＞0.05）。结论 耐碳青霉烯类肺炎克雷伯菌感染呈逐年上升趋势，以ICU中耐青霉烯类肺炎克雷伯菌感染患者最多。临床应针对其可能的预后因素，采取有效、可行的诊治和防控措施预防与减少耐碳青霉烯类肺炎克雷伯菌感染发生几率。

Distribution Characteristics of Carbapenem-resistant Klebsiella Pneumoniae in our Hospital from 2014 to 2018 and Clinical Characteristics of Infected Patients

Objective To investigate the detection of carbapenem-resistant Klebsiella pneumoniae and clinical characteristics of infected patients in a top three hospital in the past 5 years, and to provide evidence for clinical diagnosis and treatment. Methods The clinical isolates of Klebsiella pneumoniae isolates from January 2014 to December 2018 were collected, and the detection rate of carbapenem-resistant pneumoniae pneumoniae, specimen source distribution, department distribution, drug resistance, and Prognostic factors. Results A total of 690 carbapenem-resistant Klebsiella pneumoniae strains were detected, with a detection rate of 14.29%. The detection rate of carbapenem-resistant Klebsiella pneumoniae in 2018 was higher than that in 2014~2016,the difference was statistically significant (P<0.05); the top 5 sources of specimens were sputum, middle urine, blood, and incision Secretions, catheters, and top 5 undergraduate departments are ICU, Respiratory, Urology, Burns, and Neurosurgery. Among 16 antibiotics, CRKP is more than 50% resistant to 15 antibiotics. Carbapenem-resistant Klebsiella is resistant to compound Xinming, minocycline, tigecycline, and polymyxin The drug resistance rates were relatively low, which were 46.91%, 31.86%, 10.73%, and 10.10%, respectively. There were statistically significant differences between patients who failed to treat and patients who had responded to treatment with a combination of ≥3 basic diseases, there were significant differences between patients with diabetes, malignant tumors, admission to the ICU, mechanical ventilation, retention of urinary catheterization, other invasive procedures, and mixed infections (P<0.05). Patients who failed treatment and patients who were effective in treatment there was no significant difference in smoking, drinking, cardiovascular disease, nervous system disease, blood disease, chronic lung disease, chronic liver and kidney insufficiency, recent major surgery, multiple previous hospitalizations, or hospitalizations before this visit (P＞0.05). Conclusion Carbapenem-resistant Klebsiella pneumoniae infection has an upper-body trend year by year. The number of patients with penicillin-resistant Klebsiella pneumoniae infection in ICU is the highest. Clinically, according to its possible prognostic factors, effective and feasible diagnosis and treatment and prevention and control measures should be taken to prevent and reduce the incidence of carbapenem-resistant Klebsiella infection.