摘要
目的探讨耐碳青霉烯类肺炎克雷伯杆菌感染的危险因素及干预措施。方法选取2015年1月至2018年6月在温州医科大学附属第一医院脑科重症病房发生耐碳青霉烯类肺炎克雷伯杆菌感染患者88例为耐碳青霉烯组,选取同期发生的碳青霉烯敏感的肺炎克雷伯杆菌感染患者80例为碳青霉烯敏感组。统计两组感染部位分布。单因素及多因素分析耐碳青霉烯类肺炎克雷伯杆菌感染的危险因素,并探讨干预措施。结果耐碳青霉烯类肺炎克雷伯杆菌感染部位主要为下呼吸道、血液系统、泌尿道、软组织。其中耐碳青霉烯组血液系统感染率(14.77%)高于碳青霉烯敏感组(5.0%),差异有统计学意义(χ~2=4.400,P<0.05)。多因素分析结果显示:动静脉置管、抗菌药物应用时间≥14 d、应用碳青霉烯类、前期有肺炎克雷伯菌定植患者是耐碳青霉烯类肺炎克雷伯杆菌感染独立危险因素(OR=15.5,14.0,18.5,41.4,30.3,P<0.05)。结论耐碳青霉烯肺炎克雷伯菌感染的高危因素有住院时间长,青霉烯类抗菌药物应用时间≥14 d、前期有肺炎克雷伯菌定植。临床工作中应加强预防措施,对于感染耐碳青霉烯肺炎克雷伯菌的患者早发现,早隔离,并给予合理的抗感染治疗。
Objective To discuss the risk factors of carbapenem resistant Klebsiella pneumoniae infections.Methods 88 cases with carbapenem resistant Klebsiella pneumonia(CRKP)infections and 80 patients with carbapenem sensitive Klebsiella pneumonia(CSKP)infections in ICU in hospital were enrolled into the study from January 2015 to June 2018 as CRKP group and CSKP group.The infection sites of the two groups were recorded and statistically analyzed.Single variate multivariate analysis were used to analyze the risk factors of CRKP infections,and the intervention measures were discussed.Results The major infection sites were lower airway,blood,urinary tract and soft tissue.The infection rate of blood was significantly higher in CRKP group than that in CSKP group(4.77%vs 5.0%;χ~2=4.400,P<0.05).Multi-variate analysis showed that arteriovenous catheterization,antibiotics use for14 days and longer,carbapenem use and pre-colonization of Klebsiella pneumoniae were risk factors of CRKP infections(OR=15.5,14.0,18.5,41.4,30.3,P<0.05).Conclusions The high risk factors for CRKP infections are found to be longer hospital stay,the use of penicenes for 14 days and longer and the pre-colonization of Klebsiella pneumoniae.Therefore,prevention should be strengthened in clinical work and patients with CRKPI infections should be diagnosed early,isolated early and treated properly.
作者
陈晓青
陈贤斌
温鸿
高笑侠
朱蓓蕾
CHEN Xiao-qing;CHEN Xian-bin;WEN Hong;GAO Xiao-xia;ZHU Bei-lei(Intensive Care Unit,First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang,325015,Chin)
出处
《中国预防医学杂志》
CAS
CSCD
2019年第5期388-391,共4页
Chinese Preventive Medicine
基金
浙江省自然科学基金项目(LY17H160052)
关键词
耐碳青霉烯
肺炎克雷伯杆菌
危险因素
干预措施
Carbapenem resistant Klebsiella pneumoniae
Risk factors
Intervention measures
