摘要
目的分析重症监护室(ICU)患者发生耐碳青霉烯肺炎克雷伯菌(CRKP)医院感染的独立危险因素及其耐药性,为临床科学防控提供实验室依据。方法选取某医院ICU病房发生CRKP医院感染的67例患者为研究对象(CRKP组),另选67例同期、同病区碳青霉烯敏感肺炎克雷伯菌(CSKP)医院感染患者为CSKP组,对比两组临床资料。Vitek-2全自动微生物鉴定仪进行菌种鉴定和药敏试验,改良Hodge试验和PCR检测碳青霉烯酶表型和基因型。结果感染前住ICU病房≥7 d、使用碳青霉烯类药物≥7 d、与CRKP患者住同病区时间≥7 d及机械通气≥7 d是发生CRKP医院感染的危险因素(OR=3.130、8.431、6.514和5.883)。CRKP菌株对β-内酰胺类、碳青霉烯类、头孢菌素类等药物高度耐药,对复方磺胺甲噁唑和阿米卡星较敏感,对四环素和米诺环素敏感。94.0%CRKP菌株碳青霉烯酶表型阳性,89.6%携带有碳青霉烯酶基因,主要为bla_(KPC-2)。结论感染前入驻ICU≥7 d使用碳青霉烯类药物≥7 d是ICU发生CRKP感染的危险因素。该院ICU医院感染CRKP菌株耐药严重、碳青霉烯酶基因以bla_(KPC-2)为主。
Objective To explore the independent risk factors and drug resistance of nosocomial infection with carbapenem-resistant Klebsiella pneumoniae(CRKP)in intensive care unit(ICU)patients,so as to provide laboratory basis for clinical prevention and control.Methods A total of 67 patients with nosocomial infection of CRKP in ICU of one hospital were selected as CRKP group,and 67 patients with nosocomial infection of carbapenem sensitive Klebsiella pneumoniae(CSKP)in the same period and in the same ward were selected as CSKP group.The relevant clinical data were compared between the two groups.Strain identification and drug sensitivity test were conducted by Vitek-2 Compact,and carbapenenase phenotype and coding gene were detected by modified Hodge test and PCR.Results Admission to the ICU before infection≥7 days,use of carbapenems≥7 days,residence in the same ward with CRKP patients≥7 days and mechanical ventilation≥7 days were risk factors for hospital infection of CRKP(OR=3.130,8.431,6.514 and 5.883).CRKP strains were highly resistant to lactamides,carbapenems,cephalosporins and other drugs,and were relatively sensitive to sulfamethoxazole/trimethoprim and amikacin,while sensitive to tetracycline and minocycline.There were 94.0%of CRKP strains positive for carbapenem enzyme phenotype,and 89.6%carrying carbapenem enzyme genes which were mainly bla_(KPC-2).Conclusions Admission to the ICU before infection≥7 days,use of carbapenems≥7 days,residence in the same ward with CRKP patients≥7 days and mechanical ventilation≥7 days are the risk factors for nosocomial infection with CRKP in ICU.The CRKP strains isolated from this hospital have severe drug resistance and the gene of carbapenems is mainly bla_(KPC-2).
作者
朱红娟
叶春艳
范芳华
Zhu Hongjuan;Ye Chunyan;Fan Fanghua(Clinical Laboratory,General Hospital,Medical Community of Shaoxing Second Hospital,Shaoxing 312030,China;Clinical Laboratory,Zhejiang Hospital,Hangzhou 310013,China)
出处
《国际流行病学传染病学杂志》
CAS
2022年第1期38-41,共4页
International Journal of Epidemiology and Infectious Disease
基金
浙江省医药卫生科技计划(2015KYA010)。
关键词
重症监护病房
耐碳青霉烯肺炎克雷伯菌
医院感染
耐药
危险因素
基因型
Intensive care unit
Carbapenem resistant Klebsiella pneumoniae
Nosocomial infection
Drug resistance
Risk factors
Gene type
