多重耐药肺炎克雷白杆菌重症肺炎的危险因素及细菌耐药性分析

目的 探讨多重耐药肺炎克雷白杆菌重症肺炎的危险因素以及该菌对常用抗菌药物的耐药情况,为防止和减少多重耐药肺炎克雷白杆菌重症肺炎的发生以及合理使用抗生素提供参考依据.方法 采用病例对照研究,选择我院PICU 89例多重耐药肺炎克雷白杆菌重症肺炎患儿作为病例组,选择同期我院PICU 68例非多重耐药肺炎克雷白杆菌重症肺炎患儿作为对照组,对2组患儿的不合理使用抗生素（特别是三代头孢菌素）、住院时间、是否气管插管机械通气、机械通气时间、基础疾病（营养不良、先天性心脏病、遗传代谢病）共5个危险因素进行比较,并对89株多重耐药肺炎克雷白杆菌的药物敏感性进行分析。结果 病例组不合理使用抗生素（特别是三代头孢菌素）病例数（63例,占70.79％）多于对照组（27例,占39.70％）,差异有统计学意义（P＜0.01）;住院时间＞7d病例数（48例,占53.93％）多于对照组（12例,占17.65％）,差异有统计学意义（P＜0.01）;气管插管机械通气病例数（38例,占42.69％）多于对照组（16例,占23.53％）,差异有统计学意义（P＜0.05）;机械通气时间＞5d病例数（18例,占20.22％）多于对照组（5例,占7.35％）,差异有统计学意义（P＜0.05）;伴有基础疾病病例数（13例,占14.61％）多于对照组（2例,占2.94％）,差异有统计学意义（P＜0.05）。多重耐药肺炎克雷白杆菌对青霉素类、头孢菌素类、氨基糖苷类以及喹诺酮类抗生素均有较高的耐药率,而对碳青霉烯类抗生素仍保持较高的敏感率。结论 不合理使用抗生素（特别是三代头孢菌素）、住院时间长、气管插管机械通气以及机械通气时间长、原有基础疾病（营养不良、先天性心脏病、遗传代谢病）是多重耐药肺炎克雷白杆菌重症肺炎的重要危险因素;多重耐药肺炎克雷白杆菌对青霉素类、头孢菌素类、氨基糖苷类以及喹诺酮类抗生素均有较高的耐药性,但对碳青霉烯类抗生素仍有较高的敏感性;碳青霉烯类抗生素可以作为治疗多重耐药肺炎克雷白杆菌重症肺炎的首选抗菌药物。

Analysis of risk factors and bacterial drug resistance in severe pneumonia caused by multi-drug resistant Klebsiella pneumonia

Objective To explore the risk factors of severe pneumonia caused by multi-drug resistant Klebsiella pneumonia,and antimicrobial drug resistance among these isolates.It may help to prevent and control the disease and promote to rational use of antibiotics.Methods We conducted the case-control study in our PICU.It included 89 patients with severe pneumonia caused by multi-drug resistant Klebsiella pneumonia as case group and 68 patients with severe pneumonia caused by Klebsiella pneumonia as control group during the same period.To compare the two groups on irrationality use of antibiotics （especial for third generation cephalosporin）,length of stay,tracheal cannula,time of mechanical ventilation and underlying conditions （malnutrition,congenital heart disease,heredity and metabolic disease）.Antimicrobial susceptibilities among 89 multi-drug resistant Klebsiella pneumonia isolates were analyzed.Results There were 63 cases （70.79％） for irrationality use antibiotics in case group,while there were 27 cases （39.70％） in control group （P ＜ 0.01）.The cases for length of stay over 7 days in case group （48 cases,53.93％） were more than those cases with the same situation in control group （12 cases,17.65 ％） （P ＜ 0.01）.Thirty-eight cases （42.69 ％） needed mechanical ventilation therapy in case group,while 16 cases （23.53％） needed mechanical ventilation therapy in control group （P ＜ 0.01）.The cases for duration of mechanical ventilation over 5 days in case group （18 cases,20.22％） were more than those cases in control group （5 cases,7.35％） （P ＜0.05）.The cases with underlying disease in case group （13 cases,14.61％） were more than those cases in control group （2 cases,2.94％） （P ＜ 0.05）.Multi-drug resistant Klebsiella pneumonia isolates demonstrated that high-level resistance for penicillins,cephalosporins,aminoglycosides and quinolones,but still susceptible to carbapenems.Conclusion Several risk factors are associated with severe pneumonia caused by multi-drug resistant Klebsiella pneumonia,including irrational use of antibiotics （especial for third generation cephalosporin）,long term of length of stay,endotracheal intubation,long term of mechanical ventilation,and having underlying disease （malnutrition,congenital heart disease,heredity and metabolic disease）.Multi-drug resistant Klebsiella pneumonia isolates demonstrated that high-level resistance for penicillins,cephalosporins,aminoglycosides and quinolones,but still susceptible to Carbapenems.Carbapenems should be used as first-line drugs for severe pneumonia caused by multi-drug resistant Klebsiella pneumonia.