摘要
目的:调查与分析重症监护病房(ICU,Intensive Care Unit)肾功能不全患者耐碳青酶烯类肺炎克雷伯菌的分布特征及耐药特性。方法:收集2015年2月到2017年12月入住我院ICU的合并肾功能不全的感染性患者标本46例,调查标本来源与患者的临床资料,分离鉴定病原菌并进行耐药特性分析。结果:46例患者中共分离出165株耐碳青酶烯类肺炎克雷伯菌,标本来源于尿液6例,痰液20例,血液4例,肺泡灌洗液10例,分泌物3例,胆汁3例。165株耐碳青酶烯类肺炎克雷伯菌对美罗培南、亚胺培南、厄他培南、头孢噻吩、头孢噻肟、氨苄西林、阿莫西林/克拉维酸、环丙沙星的耐药率在80%以上,对哌拉西林/他唑巴坦、庆大霉素的耐药率在75%左右,对米诺环素、四环素、替加环素的耐药率均在40%以下。46例患者中,治愈16例,好转17例,无效13例,总有效率为71.74%;ICU平均住院天数为(11.48±2.11)d;总住院天数为(45.29±1.48)d,院内病死11例,病死率为23.91%。多因素Logistic回归分析结果显示深静脉置管置入(OR=1.893)、年龄≥65岁(OR=2.154)、使用碳青霉烯类抗菌药物(OR=2.041)为ICU肾功不全患者发生耐碳青酶烯类肺炎克雷伯菌感染的独立危险因素(P<0.05)。结论:ICU肾功不全患者耐碳青酶烯类肺炎克雷伯菌多来源于痰液标本,对米诺环素、四环素、替加环素的耐药性低,在临床上可以选择此类药物,合理把握用药的时间和剂量,增强抗感染的效率。同时,深静脉置管置入、年龄≥65岁、使用碳青霉烯类抗菌药物为治疗过程中主要的危险因素,在ICU肾功不全患者治疗中,应该重点考虑,提高治疗效率。
Objective: To investigate and analyze the distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae in patients with renal insufficiency in intensive care unit(ICU). Methods: From February 2015 to December 2017, 46 specimens of patients with renal insufficiency in ICU were collected. The source of specimen and the clinical data of patients were investigated, the pathogens were isolated and identified. Results: A total of 165 strains of Carbapenem resistant Klebsiella pneumoniae were isolated from 46 cases of patients. The specimens were derived from 6 cases of urine, 20 cases of sputum, 4 cases of blood, 10 cases of lavage fluid, 3 cases of secretion, 3 cases of bile. The resistance rates of 165 strains of carbapenem-resistant Klebsiella pneumoniae to meropenem, imipenem and ertapenem, retinoic acid and ciprofloxacin, cefalotin, cefotaxime, ampicillin, amoxicillin/carat were over80%, and the resistance rates to piperacillin/tazobactam and gentamicin were about 75%, and for the tetracycline and tega were below40%. Among the 46 patients, there were 16 cases were cured, 17 cases were improved, 13 cases were ineffective, and the total effective rates were 71.74%;the average hospital stay in ICU were(11.48±2.11)d;the total hospital stay were(45.29±1.48)d, and the hospital died were 11 case that the rates 23.91%. Multivariate logistic regression analysis showed deep venous catheterization(OR=1.893), age≥65 years(OR=2.154), use of carbapenem antibiotics(OR=2.041) for ICU patients with renal insufficiency Patients had independent risk factors for carcinol-resistant Klebsiella pneumoniae infection(P <0.05). Conclusion: The patients with renal insufficiency in ICU are resistant to carcinol-resistant Klebsiella pneumoniae, which are mostly derived from sputum specimens and have low resistance to minocycline, tetracycline and tigecycline. These drugs can be selected clinically. Reasonably grasp the time and dosage of medication,and enhance the efficiency of anti-infection. At the same time, deep venous catheter placement, age ≥65 years, the use of carbapenem antibiotics as the main risk factors in the treatment process, in the treatment of ICU patients with renal insufficiency, should be considered, improve treatment efficiency.
作者
喻声洋
胡玉清
方卫华
黄佳鹏
高威
王新平
YU Sheng-yang;HU Yu-qing;FANG Wei-hua;HUANG Jia-peng;GAO Wei;WANG xin-ping(Intensive care unit,Affiliated Chenggong Hospital of Xiamen University,Xiamen,Fujian,361003,China;Nephrology department,Affiliated Chenggong Hospital of Xiamen University,Xiamen,Fujian,361003,China)
出处
《现代生物医学进展》
CAS
2019年第10期1924-1928,共5页
Progress in Modern Biomedicine
基金
南京军区医学科技创新项目(15MS101)
关键词
重症监护病房
肾功能不全
耐碳青酶烯类肺炎克雷伯菌
耐药性
Intensive care unit
Renal insufficiency
Carbapenem resistant Klebsiella pneumoniae
Drug resistance
