耐碳青霉烯类肺炎克雷伯菌医院感染的危险因素分析
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摘要
目的探讨耐碳青霉烯类肺炎克雷伯菌(CRKP)医院感染的危险因素,为临床科室预防和控制其感染提供理论依据。方法收集某三甲医院2016年1月-2017年12月CRKP医院感染的患者31例,以相同分离时间段及分离病区为条件,按照1∶1配对收集31例对碳青霉烯类敏感的肺炎克雷伯菌(CSKP)医院感染者为CSKP组,分别统计两组感染部位及菌株耐药情况,对两组患者进行回顾性病例对照研究,对CRKP医院感染的危险因素进行单因素及多因素Logistic回归分析。结果 CRKP组及CSKP组均以呼吸系统感染为主,CRKP组菌株除氨苄西林外,对临床常见抗菌药物的耐药率均高于CSKP组;单因素Logistic回归分析结果显示:感染肺炎克雷伯菌(KP)前住院时间≥14d、有住院史、感染KP前使用碳青霉烯类抗菌药物及低蛋白血症是CRKP医院感染的危险因素(P<0.05);多因素Logistic回归分析结果显示:有住院史及低蛋白血症是医院感染CRKP的独立危险因素。结论应对CRKP医院感染高风险的患者进行定期监测,严格落实消毒隔离措施,降低医院感染发生率。
OBJECTIVE To explore the risk factors for nosocomial infections with carbapenem-resistant Klebsiella pneumoniae(CRKP),in order to provide theoretical basis for the clinical prevention and control of nosocomial infections with CRKP.METHODS Thirty-one patients with CRKP nosocomial infections treated in a Grade III Class A hospital from Jan.2016 to Dec.2017 were selected as the CRKP group,and thirty-one patients with nosocomial infections associated with carbapenem-susceptible K pneumoniae(CSKP)were selected at a ratio of 1:1 and assigned as the CSKP group.The infection sites and the drug resistance rates of the CRKP group and the CSKP group were statistically analyzed,and retrospective case-control analysis was performed on both groups.The risk factors for nosocomial infections with CRKP were analyzed by univariate and multivariate Logistic regression analysis.RESULTS Respiratory system was the dominant site of nosocomial infection for both the CRKP group and the CSKP group.The drug resistance rates of the CRKP group were higher than those of the CSKP group to all of the antibiotics except for ampicillin.The univariate Logistic regression analysis indicated that the risk factors for nosocomial infections with CRKP included length of hospital stay before K pneumoniainfection≥14 d,history of hospitalization,use of carbopenems before K pneumoniainfection,and hypoproteinemia(P<0.05).The multivariate Logistic regression analysis indicated that history of hospitalization and hypoproteinemia were the independent risk factors for nosocomial infections with CRKP.CONCLUSIONIt is necessary to carry out regular monitoring of the patients at high risk of CRKP nosocomial infection and rigidly implement the disinfection and isolation measures so as to reduce the incidence of nosocomial infection.
OBJECTIVE To explore the risk factors for nosocomial infections with carbapenem-resistant Klebsiella pneumoniae(CRKP),in order to provide theoretical basis for the clinical prevention and control of nosocomial infections with CRKP.METHODS Thirty-one patients with CRKP nosocomial infections treated in a Grade III Class A hospital from Jan.2016 to Dec.2017 were selected as the CRKP group,and thirty-one patients with nosocomial infections associated with carbapenem-susceptible K pneumoniae(CSKP)were selected at a ratio of 1:1 and assigned as the CSKP group.The infection sites and the drug resistance rates of the CRKP group and the CSKP group were statistically analyzed,and retrospective case-control analysis was performed on both groups.The risk factors for nosocomial infections with CRKP were analyzed by univariate and multivariate Logistic regression analysis.RESULTS Respiratory system was the dominant site of nosocomial infection for both the CRKP group and the CSKP group.The drug resistance rates of the CRKP group were higher than those of the CSKP group to all of the antibiotics except for ampicillin.The univariate Logistic regression analysis indicated that the risk factors for nosocomial infections with CRKP included length of hospital stay before K pneumoniainfection≥14 d,history of hospitalization,use of carbopenems before K pneumoniainfection,and hypoproteinemia(P<0.05).The multivariate Logistic regression analysis indicated that history of hospitalization and hypoproteinemia were the independent risk factors for nosocomial infections with CRKP.CONCLUSIONIt is necessary to carry out regular monitoring of the patients at high risk of CRKP nosocomial infection and rigidly implement the disinfection and isolation measures so as to reduce the incidence of nosocomial infection.
引文
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[10]Hu Y,Ping Y,Li L,et al.A retrospective study of risk factors for carbapenem-resistant Klebsiella pneumoniae acquisition among ICU patients[J].J Infect Dev Ctries,2016,10(3):208-213.
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[12]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
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[14]韩竖霞,周立勤,倪维.2014-2016某医院肺炎克雷伯菌的临床分布及耐药性变迁[J].中国消毒学杂志,2018,35(3):192-195.
[15]杨柳,张智洁,秦晓松.肺炎克雷伯菌对碳青霉烯类的耐药机制与危险因素[J].中国抗生素杂志,2018,43(2):163-168.
[16]Van Duin D,Doi Y.The global epidemiology of carbapenemase-producing Enterobacteriaceae[J].Virulence,2017,8(4):460-469.
[17]Pitout JD,Nordmann P,Poirel L.Carbapenemase-producing Klebsiella pneumoniae,a key pathogen set for global nosocomial dominance[J].Antimicrob Agents Chemother,2015,59(10):5873-5884.
[18]张海峰,姚静,杜兴冉,等.碳青霉烯耐药肺炎克雷伯菌医院暴发流行的耐药机制及同源性研究[J].中华医院感染学杂志,2016,26(22):5041-5045.
[19]Zhang Y,Wang Q,Yin Y,et al.Epidemiology of carbapenem-resistant Enterobacteriaceae infections:report from the China CRE Network[J].Antimicrob Agents Chemother,2018,62(2):e01882-17.
[20]Bowers JR,Kitchel B,Driebe EM,et al.Genomic analysis of the emergence and repid global dissemination of the clonal group 258 Klebsiella pneumoniae pandemic[J].PLoS One,2015,10(7):e0133727.
[21]Da Silva KE,Maciel WG,Sacchi FP,et al.Risk factors for KPC-producing Klebsiella pneumoniae:watch out for surgery[J].J Med Microbiol,2016,65(6):547-553.
[22]Kofteridis DP,Valachis A,Dimopoulou D,et al.Risk factors for carbapenem-resistant Klebsiella pneumoniae infection/colonization:a case-control study[J].J Infect Chemother,2014,20(5):293-297.
[23]Hauck C,Cober E,Richter SS,et al.Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections[J].Clin Microbiol Infect,2016,22(6):513-519.
[24]Gagliotti C,Giordani S,Ciccarese V,et al.Risk factors for colonization with carbapenemase-producing Klebsiella pneumoniae in hospital:a matched case-control study[J].Am J Infect Control,2014,42(9):1006-1008.
[25]方清永,李迎丽,邱景富.ICU耐碳青霉烯类肺炎克雷伯菌医院获得性肺炎危险因素分析[J].国际检验医学杂志,2017,38(19):2663-2665.
[26]谭莉,涂敏,彭威军,等.新生儿耐碳青霉烯类肺炎克雷伯菌医院感染相关因素分析[J].中华医院感染学杂志,2018,28(18):2811-2814.
[2]Papagiannitsis CC,Malli E,Florou Z,et al.Emergence of sequence type 11 Klebsiella pneummoniae coproducing NDM-1and VIM-1metallo-beta-lactamases in a Greek hospital[J].Diagn Microbiol Infect Dis,2017,87(3):295-297.
[3]Han JH,Goldstein EJ,Wise J,et al.Epidemiology of carbapenem-resistant Klebsiella pneumoniae in a network of long-term acute care hospitals[J].Clin Infect Dis,2017,64(7):839-844.
[4]胡付品,朱德妹,汪复,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,(15)3:401-410.
[5]Wang Z,Qin RR,Huang L,et al.Risk factors for carbapenem-resistant Klebsiella pneumoniae infection and mortality of Klebsiella pneumoniae infection[J].Chin Med J(Engl).2018,131(1):56-62.
[6]Mathers AJ,Peirano G,Pitout JD.The role of epidemic resistance plasmids and international high-risk clones in the spread of multidrug-resistant Enterobacteriaceae[J].Clin Microbiol Rev,2015,28(3):565-591.
[7]Mills JP,Talati NJ,Alby K,et al.The epidemiology of carbapenem-resistant Klebsiella pneumoniae colonization and infection among long-term acute care hospital residents[J].Infect Control Hosp Epidemiol,2016,37(1):55-60.
[8]Akturk H,Sutcu M,Somer A,et al.Carbapenem-resistant Klebsiella pneumoniae colonization in pediatric and neonatal intensive care units:risk factors for progression to infection[J].Braz J Infect Dis,2016,20(2):134-140.
[9]马红映,汪丽,虞亦鸣,等.院内获得耐碳青霉烯类抗菌药物肺炎克雷伯菌感染的危险因素分析[J].中华医院感染学杂志,2017,27(7):1456-1458.
[10]Hu Y,Ping Y,Li L,et al.A retrospective study of risk factors for carbapenem-resistant Klebsiella pneumoniae acquisition among ICU patients[J].J Infect Dev Ctries,2016,10(3):208-213.
[11]许春燕,余素飞,彭敏飞,等.耐碳青霉烯酶肺炎克雷伯菌感染的危险因素分析[J].中国乡村医院,2015,22(24):72-74.
[12]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[13]Clinical and Laboratory Standarda Institute(CLSI).Performance standards for antimicrobial susceptibility testing[J].CLSI document M100:2018.Wayne,PA:CLSI,2018.
[14]韩竖霞,周立勤,倪维.2014-2016某医院肺炎克雷伯菌的临床分布及耐药性变迁[J].中国消毒学杂志,2018,35(3):192-195.
[15]杨柳,张智洁,秦晓松.肺炎克雷伯菌对碳青霉烯类的耐药机制与危险因素[J].中国抗生素杂志,2018,43(2):163-168.
[16]Van Duin D,Doi Y.The global epidemiology of carbapenemase-producing Enterobacteriaceae[J].Virulence,2017,8(4):460-469.
[17]Pitout JD,Nordmann P,Poirel L.Carbapenemase-producing Klebsiella pneumoniae,a key pathogen set for global nosocomial dominance[J].Antimicrob Agents Chemother,2015,59(10):5873-5884.
[18]张海峰,姚静,杜兴冉,等.碳青霉烯耐药肺炎克雷伯菌医院暴发流行的耐药机制及同源性研究[J].中华医院感染学杂志,2016,26(22):5041-5045.
[19]Zhang Y,Wang Q,Yin Y,et al.Epidemiology of carbapenem-resistant Enterobacteriaceae infections:report from the China CRE Network[J].Antimicrob Agents Chemother,2018,62(2):e01882-17.
[20]Bowers JR,Kitchel B,Driebe EM,et al.Genomic analysis of the emergence and repid global dissemination of the clonal group 258 Klebsiella pneumoniae pandemic[J].PLoS One,2015,10(7):e0133727.
[21]Da Silva KE,Maciel WG,Sacchi FP,et al.Risk factors for KPC-producing Klebsiella pneumoniae:watch out for surgery[J].J Med Microbiol,2016,65(6):547-553.
[22]Kofteridis DP,Valachis A,Dimopoulou D,et al.Risk factors for carbapenem-resistant Klebsiella pneumoniae infection/colonization:a case-control study[J].J Infect Chemother,2014,20(5):293-297.
[23]Hauck C,Cober E,Richter SS,et al.Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections[J].Clin Microbiol Infect,2016,22(6):513-519.
[24]Gagliotti C,Giordani S,Ciccarese V,et al.Risk factors for colonization with carbapenemase-producing Klebsiella pneumoniae in hospital:a matched case-control study[J].Am J Infect Control,2014,42(9):1006-1008.
[25]方清永,李迎丽,邱景富.ICU耐碳青霉烯类肺炎克雷伯菌医院获得性肺炎危险因素分析[J].国际检验医学杂志,2017,38(19):2663-2665.
[26]谭莉,涂敏,彭威军,等.新生儿耐碳青霉烯类肺炎克雷伯菌医院感染相关因素分析[J].中华医院感染学杂志,2018,28(18):2811-2814.