某医院耐碳青霉烯类肺炎克雷伯菌临床感染危险因素分析
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摘要
目的分析耐碳青霉烯类肺炎克雷伯菌(CRKP)临床感染的危险因素,为CRKP医院感染预防控制提供依据。方法选取广州市某三甲中医院2016年1月至2017年12月共50例CRKP感染病例临床资料进行回顾性分析,用二分类非条件Logistic回归模型分析,对可能导致CRKP感染的相关因素进行分析,筛选其危险因素。结果单因素分析结果发现年龄、高血压、肾脏疾病、营养状况、血液透析、转入ICU、使用有创呼吸机、泌尿道插管、气管插管、深静脉置管、胃管鼻饲、感染前使用碳青霉烯类抗菌药物、联合用药和合并感染均为危险因素;多因素分析发现高血压、营养状况、气管插管和合并感染是CRKP感染的独立危险因素。结论应针对该院CRKP发生的危险因素,采取加强介入性治疗的过程管理,规范管理抗菌药物的使用流程,加强医院感染监测等,对转院、转科患者进行耐药菌筛查以避免输入性耐药菌的传播,从而预防与降低CRKP感染的发生。
Objective To analyze the risk factors of clinical infection of carbapenem resistant Klebsiella pneumoniae(CRKP)to provide a basis for the prevention and control of CRKP nosocomial infection.Methods The clinical data of 50 cases of CRKP infection in a Class 3 Ahospital of Chinese Medicine from January 2016 to December 2017 were retrospectively analyzed,and the binary unconditioned Logistic regression model was used to analyze the data.The related factors possibly causing CRKP infection were analyzed for screening out the risk factors.Results The single factor analysis results showed that the age,hypertension,kidney disease,nutritional status,hemodialysis,transfer into ICU,use of invasive ventilator,urinary catheterization,tracheal intubation,deep vein catheterization,gastric tube nasogastric feeding,carbapenems use,combined use of antibacterial drugs before infection,and complicating infection all were the risk factors;the multivariate analysis revealed that hypertension,nutritional status,endotracheal intubation and complicating infection were the independent risk factors for CRKP infection.Conclusion Aiming at the risk factors of CRKP occurrence in this hospital,adopting the measures for strengthening the process management of interventional treatment,standardizing the management of use process of antibacterial drugs and strengthening the monitoring of hospital infection,conducting the drug resistant bacterial screening in the patients transferring to another hospital and another department in order to prevent the spread of CRKP infection,thus prevent and reduce the CRKP infection occurrence.
Objective To analyze the risk factors of clinical infection of carbapenem resistant Klebsiella pneumoniae(CRKP)to provide a basis for the prevention and control of CRKP nosocomial infection.Methods The clinical data of 50 cases of CRKP infection in a Class 3 Ahospital of Chinese Medicine from January 2016 to December 2017 were retrospectively analyzed,and the binary unconditioned Logistic regression model was used to analyze the data.The related factors possibly causing CRKP infection were analyzed for screening out the risk factors.Results The single factor analysis results showed that the age,hypertension,kidney disease,nutritional status,hemodialysis,transfer into ICU,use of invasive ventilator,urinary catheterization,tracheal intubation,deep vein catheterization,gastric tube nasogastric feeding,carbapenems use,combined use of antibacterial drugs before infection,and complicating infection all were the risk factors;the multivariate analysis revealed that hypertension,nutritional status,endotracheal intubation and complicating infection were the independent risk factors for CRKP infection.Conclusion Aiming at the risk factors of CRKP occurrence in this hospital,adopting the measures for strengthening the process management of interventional treatment,standardizing the management of use process of antibacterial drugs and strengthening the monitoring of hospital infection,conducting the drug resistant bacterial screening in the patients transferring to another hospital and another department in order to prevent the spread of CRKP infection,thus prevent and reduce the CRKP infection occurrence.
引文
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[12]张帅,宋于康,钟丹锋,等.耐碳青霉烯类肺炎克雷伯菌所致的呼吸机相关性肺炎的流行病学及耐药性分析[J].中华医院感染学杂志,2017,27(4):721-724.
[13]YANG Q,WANG H,SUN H,et al.Phenotypic and genotypic characterization of Enterobacteriaceae with decreased susceptibility to carbapenems:results from large hospital-based surveillance studies in China[J].Antimicrob Agents Chemother,2010,54(1):573-577.
[14]林琳,王军,胡志军,等.耐碳青霉烯类肺炎克雷伯菌感染的临床危险因素分析[J].重庆医学,2018,47(2):236-239.
[15]李鹏,李轶,张付华,等.耐碳青霉烯类肠杆菌医院感染风险分析[J].中华医院感染学杂志,2015,25(11):2417-2419.
[16]姚志宏,刘真真.耐碳青霉烯类肺炎克雷伯菌的流行病学、耐药与传播机制研究进展[J].中国抗生素杂志,2017,42(12):1107-1112.
[17]NORDMANN P,DORTET L,POIREL L.Carbapenem resistance in Enterobacteriaceae:here is the storm![J].Trends Mol Med,2012,18(5):263-272.
[18]YIGIT H,QUEENAN A M,ANDERSON G J,et al.Novcl carbapenem-hydrolyzing beta-lactamase,KPC-1from a carbapenem-resistant strain of Klebsiella pneumoniae[J].Antimicrob Agents Chemother,2001,45(4):1151-1161.
[19]刘洋,万腊根,余阳,等.产IMP-4和KPC-2碳青霉烯酶肺炎克雷伯菌PMQR基因检测及分子流行病学研究[J].中华微生物学和免疫学杂志,2013,33(10):760.
[2]PEREIRA G H,GARCIA D O,MOSTARDEIRO M,et al.Outbreak of carbapenem-resistant Klebsiella pneumoniae:two-year epidemiologic follow-up in a tertiary hospital[J].Mem Inst Oswaldo Cruz,2013,108(1):113-115.
[3]MACKENZIE F M,FORBES K J,DORAIJOHN T,et al.Emergence of a carbapenem-resistant Klebsiella pneumoniae[J].Lancet,1997,350(980):783-785.
[4]THOMAS C P,MOORE L S,ELAMIN N,et al.Early(2008-2010)hospital outbreak of Klebsiella pneumoniae producing OXA-48carbapenemase in the UK[J].Int JAntimicrob Agents,2013,42(6):X31-X36.
[5]MUNOZ-PRICE L S,POIREL L,BONOMO R A,et al.Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases[J].Lancet Infect Dis,2013,13(9):785-796.
[6]BRATU S,MOOTY M,NICHANI S,et al.Emergence of KPC-possessing Klebsiella pneumoniae in Brooklyn,New York:epidemiology and recommendations for detection[J].Antimicrob Agents Chemother,2005,49(7):3018-3020.
[7]叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].3版.南京:东南大学出版社,2006:754-869.
[8]Clinical and Laboratory Standards Institute.Performance Standards for Antimicrobial Susceptibility Testing:Twenty-Sixth Edition:M100S[S].Wayne,PA,USA:CLSI,2016.
[9]QIN X H,YANG Y,HU F P,et al.Hospital clonal dissemination of Enterobacter aerogenes producing carbapenemase KPC-2in a Chinese teaching hospital[J].J Med Microbiol,2014,63(Pt 2):222-228.
[10]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.
[11]DAIKOS G L,MARKOGIANNAKIS A.Carbapenemaseproducing Klebsiella pneumoniae:(when)might we still consider treating with carbapenems?[J].Clin Microbiol Infect,2011,17(8):1135-1141.
[12]张帅,宋于康,钟丹锋,等.耐碳青霉烯类肺炎克雷伯菌所致的呼吸机相关性肺炎的流行病学及耐药性分析[J].中华医院感染学杂志,2017,27(4):721-724.
[13]YANG Q,WANG H,SUN H,et al.Phenotypic and genotypic characterization of Enterobacteriaceae with decreased susceptibility to carbapenems:results from large hospital-based surveillance studies in China[J].Antimicrob Agents Chemother,2010,54(1):573-577.
[14]林琳,王军,胡志军,等.耐碳青霉烯类肺炎克雷伯菌感染的临床危险因素分析[J].重庆医学,2018,47(2):236-239.
[15]李鹏,李轶,张付华,等.耐碳青霉烯类肠杆菌医院感染风险分析[J].中华医院感染学杂志,2015,25(11):2417-2419.
[16]姚志宏,刘真真.耐碳青霉烯类肺炎克雷伯菌的流行病学、耐药与传播机制研究进展[J].中国抗生素杂志,2017,42(12):1107-1112.
[17]NORDMANN P,DORTET L,POIREL L.Carbapenem resistance in Enterobacteriaceae:here is the storm![J].Trends Mol Med,2012,18(5):263-272.
[18]YIGIT H,QUEENAN A M,ANDERSON G J,et al.Novcl carbapenem-hydrolyzing beta-lactamase,KPC-1from a carbapenem-resistant strain of Klebsiella pneumoniae[J].Antimicrob Agents Chemother,2001,45(4):1151-1161.
[19]刘洋,万腊根,余阳,等.产IMP-4和KPC-2碳青霉烯酶肺炎克雷伯菌PMQR基因检测及分子流行病学研究[J].中华微生物学和免疫学杂志,2013,33(10):760.