重症监护室患者耐碳青霉烯类肺炎克雷伯菌血流感染的影响因素
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摘要
目的探究重症监护室患者耐碳青霉烯类肺炎克雷伯菌血流感染的影响因素及预防干预对策。方法回顾性分析医院重症监护室2015年1月-2017年12月收治的144例肺炎克雷伯菌血流感染患者,根据是否对碳青霉烯类抗菌药物敏感,分为碳青霉烯类敏感组(n=43)及碳青霉烯类不敏感组(n=101),探究耐碳青霉烯类肺炎克雷伯菌血流感染的影响因素。结果本研究的144例重症监护室肺炎克雷伯菌血流感染的患者中,有43例对碳青霉烯类抗菌药物敏感,占29.86%。患者有侵入性治疗、年龄、使用碳青霉烯类抗菌药物史、糖尿病、使用免疫抑制剂史、有多联抗菌药物使用史均是肺炎克雷伯菌血流感染的重症监护室患者对碳青霉烯类抗菌药物不敏感的独立危险因素(P<0.05)。结论重症监护室肺炎克雷伯菌血流感染的患者对碳青霉烯类抗菌药物不敏感的发生率较高,需要引起临床医师足够关注,采取合理的预防措施,以期达到控制感染的目的。
OBJECTIVE To explore the influencing factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection in intensive care unit(ICU) patients so as to put forward the prevention countermeasures. METHODS A total of 144 patients with K.pneumoniae bloodstream infection who were treated in the ICU from Jan 2015 to Dec 2017 were enrolled in the study and divided into the carbapenem-sensitive group with 43 cases and the carbapenem-insensitive group with 101 cases according to the sensitivity to carbapenems. The influencing factors for the carbapenem-resistant K.pneumoniae bloodstream infection were explored. RESULTS Of 144 enrolled patients with K.pneumoniae bloodstream infection, 43(29.86%) were sensitive to carbapenems. Invasive procedures, age, history of treatment with carbapenems, diabetes mellitus, use of immunosuppressors and multi-drug combined therapies were the independent risk factors for the insensitivity to carbapenems among the ICU patients with K.pneumoniae bloodstream infection(P<0.05). CONCLUSION The ICU patients with K.pneumoniae bloodstream infection are highly insensitive to carbapenems, and it is necessary for clinicians to pay great attention to and take reasonable prevention measures so as to control the infection.
OBJECTIVE To explore the influencing factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection in intensive care unit(ICU) patients so as to put forward the prevention countermeasures. METHODS A total of 144 patients with K.pneumoniae bloodstream infection who were treated in the ICU from Jan 2015 to Dec 2017 were enrolled in the study and divided into the carbapenem-sensitive group with 43 cases and the carbapenem-insensitive group with 101 cases according to the sensitivity to carbapenems. The influencing factors for the carbapenem-resistant K.pneumoniae bloodstream infection were explored. RESULTS Of 144 enrolled patients with K.pneumoniae bloodstream infection, 43(29.86%) were sensitive to carbapenems. Invasive procedures, age, history of treatment with carbapenems, diabetes mellitus, use of immunosuppressors and multi-drug combined therapies were the independent risk factors for the insensitivity to carbapenems among the ICU patients with K.pneumoniae bloodstream infection(P<0.05). CONCLUSION The ICU patients with K.pneumoniae bloodstream infection are highly insensitive to carbapenems, and it is necessary for clinicians to pay great attention to and take reasonable prevention measures so as to control the infection.
引文
[1] 马应忠,王万春.基层医院实施感染管理培训的效果探讨[J].保健医学研究与实践,2016,13(4):88-89.
[2] Ziolkowski G,Pawlowska I,Krawczyk L,et al.Antibiotic consumption versus the prevalence of multidrug-resistant Acinetobacter baumannii and Clostridium difficile infections at an ICU from 2014-2015[J].J Infect Public Health,2018,11(5):626-630.
[3] Giamarellos-Bourboulis EJ,Kotsaki A,Routsi C,et al.A prognostic score for the resolution of bacteremia by gram-negative bacteria resistant to carbapenems[J].Eur J Clin Microbiol Infect Dis,2018,37(11):2083-2089.
[4] 徐忆秋,胡仁静,万琳,等.感染耐碳青霉烯类抗菌药物的肺炎克雷伯菌患者死亡危险因素分析[J].中国职业与健康杂志,2017,12(8):12-13.
[5] Alizadeh N,Rezaee MA,Kafil HS,et al.Detection of carbapenem-resistant Enterobacteriaceae by chromogenic screening media[J].J Microbiol Methods,2018,153:40-44.
[6] 段园园,曹敬荣,闵嵘,等.住院患者肺炎克雷伯菌血流感染的临床特点与耐药分析[J].中华实验和临床感染病杂志(电子版),2016,10(6):698-702.
[7] Huang CH,Tsai JS,Chen IW,et al.Risk factors for in-hospital mortality in patients with type 2 diabetes complicated by community-acquired Klebsiella pneumoniae bacteremia[J].J Formos Med Assoc,2015,114(10):916-922.
[8] 杭欣,张波.耐碳青霉烯肺炎克雷伯菌易感因素分析[J].山西医科大学学报,2016,47(5):450-454.
[9] Federico MP,Furtado GH.Immediate and later impacts of antimicrobial consumption on carbapenem-resistant Acinetobacter spp.,Pseudomonas aeruginosa,and Klebsiella spp.in a teaching hospital in Brazil:a 10-year trend study[J].Eur J Clin Microbiol Infect Dis,2018,37(11):2153-2158.
[10] Yin D,Zhang L,Wang A,et al.Clinical and molecular epidemiologic characteristics of carbapenem-resistant Klebsiella pneumoniae infection/colonization among neonates in China[J].J Hosp Infect,2018,100(1):21-28.
[11] 方清永,李迎丽,邱景富,等.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.
[12] Garcia-Fernandez S,Hernandez-Garcia M,Valverde A,et al.CHROMagar mSuperCARBA performance in carbapenem-resistant Enterobacteriaceae isolates characterized at molecular level and routine surveillance rectal swab specimens[J].Diagn Microbiol Infect Dis,2017,87(3):207-209.
[13] Freire MP,Pierrotti LC,Filho HH,et al.Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients[J].Eur J Clin Microbiol Infect Dis,2015,34(2):277-286.
[14] 张烨,董方,宋文琪,等.产NDM-1型碳青霉烯酶肺炎克雷伯菌儿童血流感染的临床特征及细菌耐药性分析[J].中国感染与化疗杂志,2017,17(5):516-522.
[15] Papst L,Beovic B,Pulcini C,et al.Antibiotic treatment of infections caused by carbapenem-resistant gram-negative bacilli:an international ESCMID cross-sectional survey among infectious diseases specialists practicing in large hospitals[J].Clin Microbiol Infect,2018,24(10):1070-1076.
[16] 孙晔佳,顾克菊.某院耐碳青霉烯类肺炎克雷伯菌检出与耐药表型分布[J].中国感染控制杂志,2017,16(2):130-133.
[17] Hong J,Jang OJ,Bak MH,et al.Management of carbapenem-resistant Acinetobacter baumannii epidemic in an intensive careunit using multifaceted intervention strategy[J].Korean J Intern Med,2018,33(5):1000-1007.
[18] Wunderink RG,Giamarellos-Bourboulis EJ,Rahav G,et al.Effect and safety of meropenem-vaborbactam versus best-available therapy in patients with carbapenem-resistant Enterobacteriaceae infections:the TANGO II randomized clinical trial[J].Infect Dis Ther,2018,7(4):439-455.
[19] Fortini A,Faraone A,Di Pietro M,et al.Antimicrobial stewardship in an internal medicine ward:effects on antibiotic consumption and on the use of carbapenems[J].Intern Emerg Med,2018,13(8):1219-1226.
[20] 刘婧娴,俞静,李媛睿,等.肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药机制研究[J].上海交通大学学报(医学版),2016,36(1):93-99.
[21] 赵晓杰,邓丽华,施德仕,等.耐碳青霉烯类肺炎克雷伯菌耐药机制研究[J].中华医院感染学杂志,2015,14(17):3851-3853.
[22] Kim HA,Chung DR,Yeom JS,et al.Anti-anaerobic coverage is not necessary for Klebsiella pneumoniae liver abscess:a propensity score-matched cohort study[J].Diagn Microbiol Infect Dis,2015,81(1):60-65.
[23] Kim T,Lee EJ,Park SY,et al.Natural prognosis of carbapenem-resistant Acinetobacter baumannii bacteremia in patients whodid not receive appropriate antibiotic treatment:a retrospective multicenter study in Korea[J].Medicine (Baltimore),2018,97(43):e12984.
[24] 李桂秋,崔兰英,陈淑兰,等.耐碳青霉烯类肺炎克雷伯菌的耐药机制研究[J].中国微生态学杂志,2014,26(11):1272-1274.
[25] Ting SW,Lee CH,Liu JW.Risk factors and outcomes for the acquisition of carbapenem-resistant gram-negative bacillus bacteremia:a retrospective propensity-matched case control study[J].J Microbiol Immunol Infect,2018,51(5):621-628.
[2] Ziolkowski G,Pawlowska I,Krawczyk L,et al.Antibiotic consumption versus the prevalence of multidrug-resistant Acinetobacter baumannii and Clostridium difficile infections at an ICU from 2014-2015[J].J Infect Public Health,2018,11(5):626-630.
[3] Giamarellos-Bourboulis EJ,Kotsaki A,Routsi C,et al.A prognostic score for the resolution of bacteremia by gram-negative bacteria resistant to carbapenems[J].Eur J Clin Microbiol Infect Dis,2018,37(11):2083-2089.
[4] 徐忆秋,胡仁静,万琳,等.感染耐碳青霉烯类抗菌药物的肺炎克雷伯菌患者死亡危险因素分析[J].中国职业与健康杂志,2017,12(8):12-13.
[5] Alizadeh N,Rezaee MA,Kafil HS,et al.Detection of carbapenem-resistant Enterobacteriaceae by chromogenic screening media[J].J Microbiol Methods,2018,153:40-44.
[6] 段园园,曹敬荣,闵嵘,等.住院患者肺炎克雷伯菌血流感染的临床特点与耐药分析[J].中华实验和临床感染病杂志(电子版),2016,10(6):698-702.
[7] Huang CH,Tsai JS,Chen IW,et al.Risk factors for in-hospital mortality in patients with type 2 diabetes complicated by community-acquired Klebsiella pneumoniae bacteremia[J].J Formos Med Assoc,2015,114(10):916-922.
[8] 杭欣,张波.耐碳青霉烯肺炎克雷伯菌易感因素分析[J].山西医科大学学报,2016,47(5):450-454.
[9] Federico MP,Furtado GH.Immediate and later impacts of antimicrobial consumption on carbapenem-resistant Acinetobacter spp.,Pseudomonas aeruginosa,and Klebsiella spp.in a teaching hospital in Brazil:a 10-year trend study[J].Eur J Clin Microbiol Infect Dis,2018,37(11):2153-2158.
[10] Yin D,Zhang L,Wang A,et al.Clinical and molecular epidemiologic characteristics of carbapenem-resistant Klebsiella pneumoniae infection/colonization among neonates in China[J].J Hosp Infect,2018,100(1):21-28.
[11] 方清永,李迎丽,邱景富,等.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.
[12] Garcia-Fernandez S,Hernandez-Garcia M,Valverde A,et al.CHROMagar mSuperCARBA performance in carbapenem-resistant Enterobacteriaceae isolates characterized at molecular level and routine surveillance rectal swab specimens[J].Diagn Microbiol Infect Dis,2017,87(3):207-209.
[13] Freire MP,Pierrotti LC,Filho HH,et al.Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients[J].Eur J Clin Microbiol Infect Dis,2015,34(2):277-286.
[14] 张烨,董方,宋文琪,等.产NDM-1型碳青霉烯酶肺炎克雷伯菌儿童血流感染的临床特征及细菌耐药性分析[J].中国感染与化疗杂志,2017,17(5):516-522.
[15] Papst L,Beovic B,Pulcini C,et al.Antibiotic treatment of infections caused by carbapenem-resistant gram-negative bacilli:an international ESCMID cross-sectional survey among infectious diseases specialists practicing in large hospitals[J].Clin Microbiol Infect,2018,24(10):1070-1076.
[16] 孙晔佳,顾克菊.某院耐碳青霉烯类肺炎克雷伯菌检出与耐药表型分布[J].中国感染控制杂志,2017,16(2):130-133.
[17] Hong J,Jang OJ,Bak MH,et al.Management of carbapenem-resistant Acinetobacter baumannii epidemic in an intensive careunit using multifaceted intervention strategy[J].Korean J Intern Med,2018,33(5):1000-1007.
[18] Wunderink RG,Giamarellos-Bourboulis EJ,Rahav G,et al.Effect and safety of meropenem-vaborbactam versus best-available therapy in patients with carbapenem-resistant Enterobacteriaceae infections:the TANGO II randomized clinical trial[J].Infect Dis Ther,2018,7(4):439-455.
[19] Fortini A,Faraone A,Di Pietro M,et al.Antimicrobial stewardship in an internal medicine ward:effects on antibiotic consumption and on the use of carbapenems[J].Intern Emerg Med,2018,13(8):1219-1226.
[20] 刘婧娴,俞静,李媛睿,等.肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药机制研究[J].上海交通大学学报(医学版),2016,36(1):93-99.
[21] 赵晓杰,邓丽华,施德仕,等.耐碳青霉烯类肺炎克雷伯菌耐药机制研究[J].中华医院感染学杂志,2015,14(17):3851-3853.
[22] Kim HA,Chung DR,Yeom JS,et al.Anti-anaerobic coverage is not necessary for Klebsiella pneumoniae liver abscess:a propensity score-matched cohort study[J].Diagn Microbiol Infect Dis,2015,81(1):60-65.
[23] Kim T,Lee EJ,Park SY,et al.Natural prognosis of carbapenem-resistant Acinetobacter baumannii bacteremia in patients whodid not receive appropriate antibiotic treatment:a retrospective multicenter study in Korea[J].Medicine (Baltimore),2018,97(43):e12984.
[24] 李桂秋,崔兰英,陈淑兰,等.耐碳青霉烯类肺炎克雷伯菌的耐药机制研究[J].中国微生态学杂志,2014,26(11):1272-1274.
[25] Ting SW,Lee CH,Liu JW.Risk factors and outcomes for the acquisition of carbapenem-resistant gram-negative bacillus bacteremia:a retrospective propensity-matched case control study[J].J Microbiol Immunol Infect,2018,51(5):621-628.