耐碳青霉烯肺炎克雷伯菌感染的危险因素及耐药机制的研究

目的探讨耐碳青霉烯肺炎克雷伯菌感染的危险因素及耐药机制。方法对我院2018年6月1日-2019年5月31日57例耐碳青霉烯肺炎克雷伯菌(CRKP)感染患者和70例碳青霉烯敏感肺炎克雷伯菌(CSKP)感染患者进行回顾性分析。结果CRKP感染患者主要分布在呼吸科31.6%(18/57)、神经内科21.1%(12/57)、神经外科14%(8/57)和ICU 10.5%(6/57),感染部位以下呼吸道感染78.9%(45/57)和泌尿道感染17.8%(8/57)为主;相比CSKP感染组,使用两种或三种抗生素患者的比例在CRKP感染组中显著增加。多元Logistic回归分析显示,1月内使用三代头孢/酶抑制剂、1月内使用碳青霉烯类以及留置尿管为CRKP感染的独立危险因素。57株CRKP菌株中,有39株(68.4%)携带blaKPC基因,6株(10.5%)携带blaIMP基因。结论CRKP菌株日见增多,规范化使用碳青霉烯类抗生素,减少或缩短侵入性医疗操作有利于降低CRKP感染的发生率;产KPC型碳青霉烯酶是CRKP菌株对碳青酶烯类耐药的最主要耐药机制。

Risk factors and drug resistance mechanism of carbapenem-resistant Klebsiella pneumoniae infection

Objective To investigate the risk factors and drug resistance mechanism of carbapenem-resistant Klebsiella pneumoniae infection.Methods A retrospective analysis was conducted on 57 patients with carbapenem resistant Klebsiella pneumoniae(CRKP)infection and 70 patients with carbapenem sensitive Klebsiella pneumoniae(CSKP)infection in our hospital from June 1,2018 to May 31,2019.Results The patients with CRKP infection were mainly distributed in respiratory department(31.6%),neurology department(21.1%),neurosurgery department(14%)and ICU(10.5%).Lower respiratory tract infection(78.9%)and urinary tract infection(17.8%)were the main infection sites.Compared with the CSKP infection group,the proportion of patients using two or three antibiotics increased significantly in the CRKP infection group.Multiple logistic regression analysis showed that the use of third-generation cephalosporins/enzyme inhibitors within one month,carbapenem antibjotics within one month and indwelling catheter were independent risk factors for CRKP infection.Of the 57 CRKP strains,39(68.4%)carried blaKPC gene and 6(10.5%)carried blaIMP gene.Conclusion The number of CRKP strains is increasing day by day,standardizing the use of carbapenem antibiotics and reducing or shortening invasive medical procedures are beneficial to reduce the incidence of CRKP infection.The production of KPC type carbapenem is the most important mechanism of carbapenem resistance of CRKP strains.