产碳青霉烯酶革兰阴性菌感染的发生及其相关危险因素分析

目的 探讨医院产碳青霉烯酶(KPC)革兰阴性菌的感染状况以及可能危险因素.方法 将2010年1-12月医院住院患者中分离对碳青霉烯类抗菌药物敏感性下降的革兰阴性菌,以PCR法分别进行KPC测定,并分析产KPC革兰阴性菌感染的危险因素.结果 对碳青霉烯类抗菌药物敏感性下降的革兰阴性菌中,肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌、鲍氏不动杆菌等产KPC检出率分别为57.14％、50.00％、46.67％、46.15％和36.36％;痰液、尿液、血液为检出KPC阳性率的前3位标本,分别占33.85％、24.61％、15.38％；单因素和多因素分析显示,住院时间、1周内有侵入性操作、入住手术科室、入住ICU、再次入院或转院、使用碳青霉烯类抗菌药物均为产KPC阴性酶感染的危险因素.结论 医院对碳青霉烯类抗菌药物敏感性下降的革兰阴性菌中产KPC革兰阴性菌比例较高,合理使用碳青霉烯类抗菌药物、尽量缩短住院时间等是控制产KPC革兰阴性菌感染的重要措施.

Incidence and risk factors for carbapenemases-producing gram-negative bacteria infections

OBJECTIVE To investigate the status of carbapenemases-producing gram-negative bacteria infections and analyze the related risk factors.METHODS The determination of the gram-negative bacteria isolated from the hospitalized patients during Jan-Dec 2010 whose drug susceptibility to carbapenem antibiotics decreased was performed by PCR,and the risk factors for carbapenemases-producing gram-negative bacteria infections were analyzed.RESULTS Of the gram-negative bacteria whose drug susceptibility to carbapenems decreased,the detection rates of carbapenemases from Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa,Enterobacter cloacae and Acinetobacter baumannii were 57.14%,50.00%,46.67%,46.15% and 36.36%,respectively;sputum,urine and blood were the top three specimens from which carbapenemases were detected,accounting for 33.85%,24.61% and 15.38%,respectively;univariate factor analysis and multivariate factors analysis revealed that the duration of hospital stay,invasive operation within one week,hospitalized departments and ICU,readmission or transfer,and use of carbapenem antibiotics were the risk factors for carbapenemases-producing gram-negative bacteria infections.CONCLUSION The bacteria whose drug susceptibility to carbapenems decreases take a large proportion among carbapenemases-producing gram-negative bacteria;to reasonably use carbapenems antibiotics and shorten the hospital stay as much as possible is crucial to the control of carbapenemase-producing gram-negative bacteria infections.