心胸外科术后继发耐碳青霉烯类肺炎克雷伯菌的临床观察及经验分享

目的 探讨心胸外科术后继发院内耐碳青霉烯类肺炎克雷伯菌（Carbapenem-resistant Klebsiella Pneumoniae，CRKP)感染的临床特点及治疗效果，为临床合理选用抗菌药物提供依据。方法 回顾分析上海交通大学附属新华医院心胸外科监护室2018年6月至2019年1月发生的13例CRKP感染的临床资料，分析其感染特点、治疗药物及预后转归等情况。结果13例患者共分离出21株CRKP菌株，血流感染3例，胸水感染4例，手术切口感染1例，肺部感染13例。高龄、机械通气时间延长及气管切开是主要危险因素。13例患者均采用了联合用药，11例以替加环素或多粘菌素b为基础，联合碳青霉烯类或非碳青霉烯类药物；2例使用亚胺培南联合阿米卡星。13例患者死亡8例。结论 心胸外科术后继发院内CRKP感染的耐药谱广、临床可选用的抗菌药物有限，预后不佳。

Clinical Observation and Experience Sharing of Carbapenem-resistant Klebsiella Pneumoniae after Cardiothoracic Surgery

Objective To investigate the clinical features and therapeutic effects of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection in patients after cardiothoracic surgery, and to provide evidence for clinical rational selection of antibiotics. Methods The clinical data of 13 cases of CRKP infection from June 2018 to January 2019 in the Cardiothoracic Surgery Department of Xinhua Hospital affiliated to Shanghai Jiao Tong University were retrospectively analyzed. The infection characteristics, therapeutic drugs and prognosis outcomes were analyzed. Results A total of 21 carotenoid-resistant Klebsiella pneumoniae strains were isolated from 13 patients, 3 with bloodstream infection, 4 with pleural fluid infection, 1 with surgical incision infection, and 13 with pulmonary infection. Old age, prolonged mechanical ventilation, and tracheotomy are major risk factors. All 13 patients were treated with a combination. The treatment regimen of 11 patients was based on tigecycline or polymyxin b combined with carbapenems or non-carbapene. Two cases used carbapenems in combination with amikacin. Eighteen patients died in 8 patients. Conclusions Cardiothoracic surgery has a wide spectrum of drug resistance to carbapenem-resistant Klebsiella pneumoniae (CRKP) infection, limited clinical antibiotics, and poor prognosis.