重症监护病房肺炎克雷伯菌临床特点及耐药分析
|
摘要
目的分析重症监护病房(ICU)肺炎克雷伯菌感染的临床特点及耐药情况,为临床合理使用抗菌药物提供依据。方法回顾性分析重庆医科大学附属第一医院2014年1月～2016年12月ICU肺炎克雷伯菌感染病例483例,药敏试验采用纸片扩散法,双纸片协同试验进行超广谱β内酰胺酶检测,WHONET5.6及SPSS 21.0软件统计分析数据。结果 ICU肺炎克雷伯菌感染常见于伴多种易患因素的老年患者,下呼吸道为主要感染部位;CREKp感染死亡率高,多合并感染性休克或多器官功能障碍。3年来ICU检出肺炎克雷伯菌对常用抗菌药物耐药率不同程度上升,特别是CREKp菌株分离逐渐增加且呈泛耐药特点,仅对替加环素、米诺环素敏感。结论 ICU肺炎克雷伯菌感染发病率高且病情重,CREKp感染死亡风险高,应充分认识其严重性。治疗上依据药敏试验结果指导临床选择适当抗菌药物尤为重要。
Objective To analyze the clinical characteristics and drug resistance of K. pneumoniae in ICU, and provide evidence for the rational use of antibiotics in clinical practice. Methods The K.pneumoniae infections in ICU from January 2014 to December 2016 were analyzed. Drug susceptibility test adopted disk diffusion method. Extended-spectrum β-lactamase was detected with double-disc synergy test.Results K. pneumoniae infection in our hospital ICU was common in elderly patients with multiple predisposing factors. Respiratory tract was the main infection site. Patients with CREKp had a high mortality rate. Most of them were associated with septic shock or multiple organ failure. The resistance rate of the detected strains to the commonly used antibiotics increased to varying degrees. Particularly CREKp strains was gradually increasing and characterized by pan-drug resistance, only sensitive to tigecycline and minocycline.Conclusion The incidence of K. pneumoniae infection in ICU is high and the disease is serious. The mortality of CREKp infection is high. We should fully recognize its seriousness. It is especially important to guide the clinical selection of appropriate antibiotics based drug susceptibility testing results.
Objective To analyze the clinical characteristics and drug resistance of K. pneumoniae in ICU, and provide evidence for the rational use of antibiotics in clinical practice. Methods The K.pneumoniae infections in ICU from January 2014 to December 2016 were analyzed. Drug susceptibility test adopted disk diffusion method. Extended-spectrum β-lactamase was detected with double-disc synergy test.Results K. pneumoniae infection in our hospital ICU was common in elderly patients with multiple predisposing factors. Respiratory tract was the main infection site. Patients with CREKp had a high mortality rate. Most of them were associated with septic shock or multiple organ failure. The resistance rate of the detected strains to the commonly used antibiotics increased to varying degrees. Particularly CREKp strains was gradually increasing and characterized by pan-drug resistance, only sensitive to tigecycline and minocycline.Conclusion The incidence of K. pneumoniae infection in ICU is high and the disease is serious. The mortality of CREKp infection is high. We should fully recognize its seriousness. It is especially important to guide the clinical selection of appropriate antibiotics based drug susceptibility testing results.
引文
[1] Lockhart S R,Abramson M A,Beekmann S E.et al.Antimicrobial resistance among Gram-negative bacilli causing infections in Intensive Care Unit patients in the United States between 1993 and 2004[J].J Clin Microbiol,2007,45(10):3352-3359.
[2] 胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[3] 李凡,徐志凯.医学微生物学.第8版[M].北京:人民卫生出版社,2013:121-122.
[4] Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].Twentyfourth informational supplement,2014,M100-S24.
[5] Magiorakos A P,Srinivasan A,Carey R B,et al.Multidrug-resistant,extensively drug-resistant and pandrug-resistant bacteria:an international expert proposal for interim standard definitions for acquired resistance[J].Clin Microbiol Infect,2012,18(3):268-281.
[6] 黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中华医院感染学杂志,2015,14 (1):1-9.
[7] Papadimitriou-Olivgeris M,Marangos M,Christofidou M,et al.Risk factors for infection and predictors of mortality among patients with KPC-producing Klebsiella pneumoniae bloodstream infections in the intensive care unit[J].Scandinavian Journal of Infectious Diseases,2014,46(9):642-648.
[8] Xu L,Sun X,Ma X.Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae[J].Annals of Clinical Microbiology & Antimicrobials,2017,16(1):18-30.
[9] 周华,李光辉,陈佰义,等.中国产超广谱β-内酰胺酶肠杆菌科细菌感染应对策略专家共识[J].中华医学杂志,2014,94(24):1847-1856.
[10] 吴娜,褚云卓,田素飞,等.抗菌药物对产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌接种效应的研究[J].中国感染与化疗杂志,2011,11(1):31-35.
[11] 王明贵.广泛耐药革兰阴性菌感染的实验诊断、抗菌治疗及医院感染控制:中国专家共识[J].中国感染与化疗杂志,2017,17(1):82-92.
[12] Paul M,Carmeli Y,Durante-Mangoni E,et al.Combination therapy for carbapenem-resistant Gram-negative bacteria[J].Expert Review of Anti-infective Therapy,2013,11(12):1333-1353.
[13] Yuan Z ,Tam V H .Polymyxin B:a new strategy for multidrug-resistant Gram-negative organisms[J].Medical Journal of West China,2017,17(5):661-668.
[14] Petrosillo N,Giannella M,Lewis R,et al.Treatment of carbapenem-resistant Klebsiella pneumoniae:the state of the art[J].Expert review of anti-infective therapy,2013,11(2):159-177.
[15] Daikos G L,Markogiannakis A.Carbapenemase‐producing Klebsiella pneumoniae:(when) might we still consider treating with carbapenems[J].Clinical Microbiology & Infection,2011,17(8):1135-1141.
[16] Daikos G L ,Tsaousi S ,Tzouvelekis L S ,et al.Carbapenemase-producing Klebsiella pneumoniae bloodstream infections:lowering mortality by antibiotic combination schemes and the role of carbapenems[J].Antimicrobial Agents & Chemotherapy,2014,58(4):2322-2328.
[17] Jacobs D M ,Safir M C ,Huang D ,et al.Triple combination antibiotic therapy for carbapenemase-producing Klebsiella pneumoniae:a systematic review[J].Annals of Clinical Microbiology and Antimicrobials,2017,16(1):76-98.
[18] Falcone M,Paterson D.Spotlight on ceftazidime/avibactam:a new option for MDR Gram-negative infections[J].Journal of Antimicrobial Chemotherapy,2016,71(10):2713-2723.
[19] Bassetti M,Peghin M,Pecori D.The management of multidrug-resistant Enterobacteriaceae[J].Current Opinion in Infectious Diseases,2016,29(6):583-594.
[20] Trecarichi E M,Tumbarello M.Therapeutic options for carbapenem-resistant Enterobacteriaceae infections[J].Virulence,2017,8(4):470-484.
[2] 胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[3] 李凡,徐志凯.医学微生物学.第8版[M].北京:人民卫生出版社,2013:121-122.
[4] Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].Twentyfourth informational supplement,2014,M100-S24.
[5] Magiorakos A P,Srinivasan A,Carey R B,et al.Multidrug-resistant,extensively drug-resistant and pandrug-resistant bacteria:an international expert proposal for interim standard definitions for acquired resistance[J].Clin Microbiol Infect,2012,18(3):268-281.
[6] 黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中华医院感染学杂志,2015,14 (1):1-9.
[7] Papadimitriou-Olivgeris M,Marangos M,Christofidou M,et al.Risk factors for infection and predictors of mortality among patients with KPC-producing Klebsiella pneumoniae bloodstream infections in the intensive care unit[J].Scandinavian Journal of Infectious Diseases,2014,46(9):642-648.
[8] Xu L,Sun X,Ma X.Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae[J].Annals of Clinical Microbiology & Antimicrobials,2017,16(1):18-30.
[9] 周华,李光辉,陈佰义,等.中国产超广谱β-内酰胺酶肠杆菌科细菌感染应对策略专家共识[J].中华医学杂志,2014,94(24):1847-1856.
[10] 吴娜,褚云卓,田素飞,等.抗菌药物对产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌接种效应的研究[J].中国感染与化疗杂志,2011,11(1):31-35.
[11] 王明贵.广泛耐药革兰阴性菌感染的实验诊断、抗菌治疗及医院感染控制:中国专家共识[J].中国感染与化疗杂志,2017,17(1):82-92.
[12] Paul M,Carmeli Y,Durante-Mangoni E,et al.Combination therapy for carbapenem-resistant Gram-negative bacteria[J].Expert Review of Anti-infective Therapy,2013,11(12):1333-1353.
[13] Yuan Z ,Tam V H .Polymyxin B:a new strategy for multidrug-resistant Gram-negative organisms[J].Medical Journal of West China,2017,17(5):661-668.
[14] Petrosillo N,Giannella M,Lewis R,et al.Treatment of carbapenem-resistant Klebsiella pneumoniae:the state of the art[J].Expert review of anti-infective therapy,2013,11(2):159-177.
[15] Daikos G L,Markogiannakis A.Carbapenemase‐producing Klebsiella pneumoniae:(when) might we still consider treating with carbapenems[J].Clinical Microbiology & Infection,2011,17(8):1135-1141.
[16] Daikos G L ,Tsaousi S ,Tzouvelekis L S ,et al.Carbapenemase-producing Klebsiella pneumoniae bloodstream infections:lowering mortality by antibiotic combination schemes and the role of carbapenems[J].Antimicrobial Agents & Chemotherapy,2014,58(4):2322-2328.
[17] Jacobs D M ,Safir M C ,Huang D ,et al.Triple combination antibiotic therapy for carbapenemase-producing Klebsiella pneumoniae:a systematic review[J].Annals of Clinical Microbiology and Antimicrobials,2017,16(1):76-98.
[18] Falcone M,Paterson D.Spotlight on ceftazidime/avibactam:a new option for MDR Gram-negative infections[J].Journal of Antimicrobial Chemotherapy,2016,71(10):2713-2723.
[19] Bassetti M,Peghin M,Pecori D.The management of multidrug-resistant Enterobacteriaceae[J].Current Opinion in Infectious Diseases,2016,29(6):583-594.
[20] Trecarichi E M,Tumbarello M.Therapeutic options for carbapenem-resistant Enterobacteriaceae infections[J].Virulence,2017,8(4):470-484.