摘要
目的:探讨上海市第十人民医院崇明分院耐碳青霉烯肺炎克雷伯菌(CRKP)的感染风险因素及耐药基因特征。方法:收集2017年6月至2023年6月该院103例CRKP感染患者及327例非CRKP感染患者的临床资料,采用多因素Logistic回归分析确定影响CRKP感染的危险因素,采用PCR法检测CRKP菌株的耐药基因和毒力基因表达情况,并进行荚膜血清分型。结果:多因素Logistic回归分析结果显示,使用抗菌药物≥3种、机械通气、使用导尿管、合并基础疾病≥3种、血清白蛋白<30 g/L是导致患者发生CRKP感染的独立危险因素(P<0.05);携带KPC基因者73株(占70.87%),携带NDM基因者12株(占11.65%),携带VIM基因者7株(占6.80%),携带OXA-48基因者4株(占3.88%);毒力基因检测结果显示,rmpA、rmpA2、iroN、iroB、peg-344、iutA检出率分别为16.50%、18.45%、17.48%、12.62%、8.74%和18.45%。结论:该院住院患者的CRKP感染受到多种因素的影响,主要耐药基因为KPC、NDM和VIM,且部分菌株携带高毒力基因。临床工作需加强对高危人群的感染防控,防止细菌传播。
Objective:To investigate the risk factors and resistance gene characteristics of carbapenem resistant Klebsiella pneumoniae(CRKP)infections in the Chongming Branch of Shanghai Tenth People's Hospital.Methods:Clinical data were collected from 103 patients with CRKP infections and 327 patients with non-CRKP infections between June 2017 and June 2023.Multivariate Logistic regression analysis was used to identify the risk factors for CRKP infections.PCR was employed to detect the expression of resistance and virulence genes in CRKP strains,and capsular serotyping was performed.Results:The result of multivariate Logistic regression analysis showed that using≥3 antimicrobial agents,mechanical ventilation,using urinary catheters,having≥3 kinds of underlying diseases,and having serum albumin levels<30 g/L were independent risk factors for patients to develop CRKP infection(P<0.05).There were 73 strains(accounting for 70.87%)carrying the KPC gene,12 strains(accounting for 11.65%)carrying the NDM gene,7 strains(accounting for 6.80%)carrying the VIM gene,and 4 strains(accounting for 3.88%)carrying the OXA-48 gene.Virulence gene detection revealed the following rates:rmpA(16.50%),rmpA2(18.45%),iroN(17.48%),iroB(12.62%),peg-344(8.74%),and iutA(18.45%).Conclusion:CRKP infections in hospitalized patients are influenced by multiple factors,with KPC,NDM,and VIM being the predominant resistance genes.Some strains also carry high-virulence genes.Clinical efforts should be enhanced to prevent infections in high-risk populations and to curb bacterial transmission.
作者
盛成兰
Sheng Chenglan(Chongming Branch of Shanghai Tenth People's Hospital,Shanghai 202157,China)
出处
《大理大学学报》
2025年第2期55-59,共5页
Journal of Dali University
基金
上海市崇明区“可持续发展科技创新计划”项目(CKY2018-27)。
关键词
耐碳青霉烯肺炎克雷伯菌
危险因素
耐药
毒力基因
carbapenem resistant Klebsiella pneumoniae
risk factor
antibiotic resistance
virulence gene
