呼吸机相关性肺炎患者耐碳青霉烯类肺炎克雷伯菌病原菌分析及耐药性监测

目的分析ICU呼吸机相关性肺炎患者耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的临床危险因素,并监测其耐药性,为CRKP感染的防控和治疗提供依据。方法收集我院2017年3月-2019年3月重症医学科发生肺炎克雷伯菌感染肺炎的患者共64例,其中23例患者感染耐碳青霉烯类肺炎克雷伯菌(CRKP组),41例对碳青霉烯类抗菌药物敏感的肺炎克雷伯菌感染患者(CSKP组),分析两组患者基本情况、检出CRKP情况、CRKP携带的耐药基因及ST型情况,并行耐药性分析。结果有慢性肺病、机械通气时间≥7 d、感染前使用抗菌药物≥7 d、使用抗菌药物种类>2种,以及使用过碳青霉烯类抗生素的患者检出CRKP概率更高;CRKP检出耐药基因有KPC-2(100%)、CTX-M-24(95.65%)、ompk35(95.65%)、ompk36(91.30%)、SHV-12(82.61%)、TEM-1(86.96%),NDM-1(8.70%), ST11型菌株所占78.26%,ST23型8.70%、ST25型8.70%,ST37型4.35%;CRKP对哌拉西林/他唑巴坦、头孢他啶、头孢曲松耐药性达100.00%,对替加环素4.35%、四环素8.70%、复方新诺明13.04%。结论 CRKP危险因素、耐药基因和种类较多,临床应针对可能的危险因素和耐药情况,采取相对应预防和治疗,从而预防与减少CRKP感染发生。

Analysis and drug resistance monitoring of Klebsiella pneumoniae resistant to carbapenem in patients with ventilator-associated pneumonia

Objective To analyze the clinical risk factors of carbapenem resistant Klebsiella pneumoniae(CRKP) infection in patients with ventilator-associated pneumonia, and to monitor its drug resistance, so as toprovide basis for the prevention and treatment of CRKP infection. Methods A total of 64 patients with Klebsiella pneumoniae infection from March 2017 to March 2019 in the Department of critical medicine of our hospital were collected. Among them,23 patients were infected with Klebsiella pneumoniae resistant to carbapenem( the CRKP group),and 41 patients with Klebsiella pneumoniae sensitive to carbapenem antibiotics( the CSKP group). Their basic situation,the detection of CRKP,the drug-resistant gene of CRKP carried and ST type were analyzed,and drug resistance was also analyzed. Results Patients with chronic lung disease,mechanical ventilation time ≥ 7 days,antibiotics used before infection ≥7 days,antibiotics used > 2 kinds and carbapenems were more likely to be infected with CRKP. The resistance genes of CRKP were kpc-2( 100%),ctx-m-24( 95. 65%),OmpK 35( 95. 65%),OmpK 36( 91. 30%),SHV-12( 82. 61%),TEM-1( 86. 96%) and NDM-1( 8. 70%). The genotype of ST11 accounted for 78. 26%,ST23 for 8. 70%,and ST 37 for 4. 35%. The resistance rate of CRKP to piperacillin/tazobactam,ceftazidime and ceftriaxone was 100%,4. 35% to tegacyclin,8. 70% to tetracycline and 13. 04% to compound neoforman. Conclusion There are many risk factors,drug resistance genes and types of CRKP. We should take prevention and treatment according to the possible risk factors and drug resistance,so as to prevent and reduce the incidence of CRKP infection.