碳青霉烯类耐药的肺炎克雷伯菌感染患者的治疗效果及预后因素评价
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- 英文论文题名：Analysis of Therapeutic Effect And Prognosis Factors For The Infection of Carbapenem-resistant Klebsieila Pneumonia in Patients
- 论文作者：刘敏 ; 徐萍 ; 杨婉花 ; 何娟
- 英文论文作者：LIU Min ; Xu Ping ; Yang Wan-Hua ; HE Juan ; Department of pharmacy ; The Fifty Centry Hospital of Tianjin ; Department of pharmacy ; Ruijin Hospital ; Shanghai Jiaotong University School of Medicine
- 年：2016
- 作者机构：天津市第五中心医院药剂科;上海交通大学医学院附属瑞金医院药剂科;
- 论文关键词：碳青霉烯类 ; 耐药 ; 肺炎克雷伯菌 ; 治疗效果 ; 影响因素
- 英文论文关键词：Carbapenem ; Drug resistance ; Klebsiella Pneumonia ; Treatment efficacy ; Risk factors
- 会议召开时间：2016-09-27
- 会议录名称：中国药学会第十三届青年药学科研成果交流会论文集
- 语种：中文
- 分类号：R516
- 学会代码：YYWS
- 会议名称：中国药学会第十三届青年药学科研成果交流会
- 会议地点：中国江西南昌
- 主办单位：中国药学会
- 学会名称：中国药学会
- 页数：7
- 文件大小：622k
- 原文格式：O
- 会议级别：全国
摘要
目的:研究碳青霉烯类耐药的肺炎克雷伯菌(Carbapenem-resistant Klebsiella pneumoniae,CRKP)感染患者的治疗效果,并对疗效的影响因素进行分析,为优化临床治疗方案提供参考。方法:2009年12月~2013年11月某三甲医院不同病区患者住院治疗期间分离和培养得到CRKP,确诊为感染的病例共91例纳入本研究。收集患者的临床资料,并随访患者的抗感染治疗效果。分别采用单因素分析方法和多元1ogistic回归方法分析患者抗感染治疗效果的影响因素。结果:91例患者经治疗后,治愈26例(28.57%),好转38例(41.76%),无效27例(29.67%);单因素分析显示:入院前90天内住院史、感染类型、机械通气时间、合并其他细菌感染、合并真菌感染、病原学分离和培养阳性后的首选治疗方案对患者治疗的总体有效率有影响(P<0.05或P<0.01),入院前90天内住院史、感染类型、机械通气时间、合并其他细菌感染对治愈率有影响(P<0.05或P<0.01);多元logistic回归分析显示,各因素对患者总体有效率无影响;而入院前90天内住院史、机械通气对治愈率有影响。结论:CRKP感染患者临床预后较差。应严格控制临床抗菌药物的使用,减少CRKP的出现,对改善CRKP感染患者临床预后有益。入院前90天内是否有住院史、机械通气对患者的临床预后有影响,制定抗感染治疗方案时应充分考虑。
Objective To investigate the clinical efficacy in the patients infected by Carbapenem-resistant Klebsiella Pneumonia in our hospital,and analyze the influencing factor to the clinical efficacy,and to provide the valuable references for the clinical treatment.Methods A total of 91 patients with nosocomial infection,in which Carbapenem-resistant Klebsiella Pneumonia was separated and cultivated,were included in the different endemic area in our hospital in Dec,2011- Nov,2013.The general clinical data of each case were collected,and the anti-infective therapy effect of each case was followed up.The influencing factors to the clinical efficacy were analyzed by single-factor analysis and multivariate logistic regression analysis.Results There are 26 cases(28.57%) with cured effect,38 cases(41.76%) with improved effect,and 27 cases(29.67%) with null effect;The results of single-factor analysis shows that hospitalization in 90 days before CRKP virus isolation and culture positive,the type of infection,duration of mechanical ventilation,.combined with fungal infection,first treatment after pathogen isolation and culture positive had the effect on the Overall efficiency(P<0.05 or P<0.01),the others have no effect on the Overall efficiency(P>0.05);and hospitalization in 90 days before CRKP virus isolation and culture positive.the type of infection,duration of mechanical ventilation and combined with other bacterial infections had the effect on the cure rate(P<0.05 or PO.01),the others have no effect on the cure rate(P>0.05);Multivariate logistic regression analysis results show that all factors had no effect on the Overall efficiency(P>0.05),hospitalization in 90 days before CRKP virus isolation and culture positive,duration of mechanical ventilation had the effect on the cure rate(P<0.05 or P<0.01).Conclusions The clinical efficacy in the patients infected by Carbapenem-resistant Klebsiella Pneumonia was poor.It is better to improve the clinical efficacy in the patients infected by Carbapenem-resistant Klebsiella Pneumonia to use antibacterial drugs strictly in clinic and reduce the appearance of Carbapenem-resistant Klebsiella Pneumonia.The hospital stay history,hospital stay with positive etiology and the antibiotic resistance condition had the effect on the clinical efficacy,which should be considered when the antibacterial treatment progress is decided.
Objective To investigate the clinical efficacy in the patients infected by Carbapenem-resistant Klebsiella Pneumonia in our hospital,and analyze the influencing factor to the clinical efficacy,and to provide the valuable references for the clinical treatment.Methods A total of 91 patients with nosocomial infection,in which Carbapenem-resistant Klebsiella Pneumonia was separated and cultivated,were included in the different endemic area in our hospital in Dec,2011- Nov,2013.The general clinical data of each case were collected,and the anti-infective therapy effect of each case was followed up.The influencing factors to the clinical efficacy were analyzed by single-factor analysis and multivariate logistic regression analysis.Results There are 26 cases(28.57%) with cured effect,38 cases(41.76%) with improved effect,and 27 cases(29.67%) with null effect;The results of single-factor analysis shows that hospitalization in 90 days before CRKP virus isolation and culture positive,the type of infection,duration of mechanical ventilation,.combined with fungal infection,first treatment after pathogen isolation and culture positive had the effect on the Overall efficiency(P<0.05 or P<0.01),the others have no effect on the Overall efficiency(P>0.05);and hospitalization in 90 days before CRKP virus isolation and culture positive.the type of infection,duration of mechanical ventilation and combined with other bacterial infections had the effect on the cure rate(P<0.05 or PO.01),the others have no effect on the cure rate(P>0.05);Multivariate logistic regression analysis results show that all factors had no effect on the Overall efficiency(P>0.05),hospitalization in 90 days before CRKP virus isolation and culture positive,duration of mechanical ventilation had the effect on the cure rate(P<0.05 or P<0.01).Conclusions The clinical efficacy in the patients infected by Carbapenem-resistant Klebsiella Pneumonia was poor.It is better to improve the clinical efficacy in the patients infected by Carbapenem-resistant Klebsiella Pneumonia to use antibacterial drugs strictly in clinic and reduce the appearance of Carbapenem-resistant Klebsiella Pneumonia.The hospital stay history,hospital stay with positive etiology and the antibiotic resistance condition had the effect on the clinical efficacy,which should be considered when the antibacterial treatment progress is decided.
引文
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[20]Zarkotou O,Pournaras S,Tselioti P,et al.Predictors of mortality inpatients with bloodstream infections caused by KPC producing Klehsiella pneumoniae and impact ofappropriate anti-microbial treatment[J].Clin Microbiol Infect,2011.17(12):1798-1803.
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[23]杨凯平,任艳军,周红莉,等.急诊重症监护病房医院感染管理的进展[J].中华医院感染学杂志,2009,19(9):1169-1170.
[24]Zubair AQ,David LP,Brian AP,et al.Treatment Outcome of Bacteremia Due to KPC-Producing Klebsiella pneumoniae:Superiority of Combination Antimicrobial Regimens[J].Antimicrobial Agents and Chemotherapy,April 2012,56(4):2108-2113.
[25]Grace CL,David SB.Treatment of Klebsiella pneumoniae Carbapenemase(KPC)infections:a review of published case series and case reports[J].Lee and BurgessAnnals of Clinical Microbiology and Antimicrobials.2012.
[26]Matthew EF,Drosos EK,Patrice Nord.Therapeutic options for infections with Enterobacteriaceae producing carbapenem-hydrolyzing enzymes[J].Future Microbiol,2011,6(6):653-666.
[27]G.Samonis,S.Maraki,D.E.Kara,et al.Synergy of fosfomycin with carbapenems,colistin,netilmicin,and tigecycline against multidrug-resistant Klebsiella pneumoniae,Escherichia coli,and Pseudomonas aeruginosa clinical isolates[J].Eur J Clin Microbiol Infect Dis,2012,3(1):695-701.
[2]Goulenok TM,Majed K,Monchi M.Role and impact of carbapenem in nosocomial infections[J].Recent Pat Antiinfect Drug Discov,2011,6(1):45-53.
[3]程训民,张琪,沈继录,等.产超广谱B2内酰胺酶表型及基因型分布[J].中华医院感染学杂志,2005,15(1):142-145.
[4]胡云建,俞云松,张秀珍,等.产超广谱B2内酰胺酶细菌的分子流行病学研究[J].中华医院感染学杂志,2004,14(3):241-244.
[5]Bradford PA,Bratu S,Urban C,et al.Emergence of carbapenem-resistant Klebsiella species possessing the class A carbapenem-hydrolyzing KPC-2 and inhibitor-resistant TEM-30 beta-lactamases in New York City[J].Clin Infect Dis,2004,39(1):55-60.
[6]Pasteran FG,Otaegui L,Guerriero L,et al.Klebsiella pneumonia Carbapenemase-2,Buenos Aires,Argentina[J].Emerg Infect Dis,2008,14(7):1178-1180.
[7]Bratu S,Landman D,Haag R,et al.Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City:a new threat to our antibiotic armamentarium[J].Arch Intern Med,2005,165(12):1430-1435.
[8]梁彬,李云慧.耐碳青霉烯类肺炎克雷伯菌血流感染的预后分析[J].山西医药杂志,2012,41(9):856-857.
[9]Schwaber MJ,Klarfeld-Lidji S,Navon-Venezia S,et al.Predictors of carbapenem-resistant Klebsiella pneumonia acquisition among hospitalized adults and effect of acquisition on mortality[J].Antimicrob Agents Chemother,2008,52(3):1028-1033.
[10]Debby BD,Ganor O,Yasmin M,et al.Epidemiology of carbapenem resistant Klebsiella pneumoniae colonization in an intensive care unit.Eur J Clin Microbiol Infect Dis,2012,34(1):14.
[11]中华人民共和国卫生部.医院感染诊断标准(试行)[S].中华医学杂志,2001,81:314-320.
[12]Clinical and laboratory Standards Institute.Performance Standards for Antimicrobial Susceptibility Testing Twentieth Informational Supplement.CLSI document M 100-S20[S].Wayne,Pennsylvania,2010:1-160.
[13]Clinical and laboratory Standards Institute.Performance Standards for Antimicrobial Susceptibility Testing Twentieth Informational Supplement.CLSI documentM 100-S20[S].Wayne,Pennsylvania,2011:1-160.
[14]黄群,朱立颖.综合ICU院内感染的因素及护理对策[J].中国实用护理杂志,2013,4(29):13-14.
[15]Skopkova-Zarnayova M,Siebor E,Rovna D,et al.Outer membrane protein profiles of clonally related Klebsiella pneumoniae isolates that differ in cefoxitin resistance[J].FEMS Microbiol Lett,2005,243(1):197-203.
[16]Bratu S,Landman D,Haag R,et al.Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City:a new threat to our antibiotic armamentarium[J].Arch Intern Med,2005,165(12):1430-1435.
[17]刘春涛,崔巍.I C U耐碳青霉烯类肺炎克雷伯菌感染患者的预后分析[J].中华医院感染学杂志,2013,23(2):283-285.
[18]Debby BD,Ganor O,Yasmin M,et al.Epidemiology of carbapenem resistant Klebsiella pneumoniae colonization in an intensive care unit.Eur J Clin Microbiol Infect Dis,2012,34(1):14-15.
[19]Mario T,Pierluigi V,Claudio V,et al.Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K.pneumoniae importance of combination therapy[J].Clinical Infectious Diseases 2012;55(7):943-950.
[20]Zarkotou O,Pournaras S,Tselioti P,et al.Predictors of mortality inpatients with bloodstream infections caused by KPC producing Klehsiella pneumoniae and impact ofappropriate anti-microbial treatment[J].Clin Microbiol Infect,2011.17(12):1798-1803.
[21]Srinivasan A,Patel JB.Klebsiella pneumoniae carbapenemase-producing organisms:an ounce of prevention really is worth a pound of cure[J].Infect Control Hosp Epidemiol,2008,29(12):1107-1109.
[22]王辉.21世纪,XDR、PDR革兰阴性杆菌挑战临床.中国医学论坛报,2012-04-27
[23]杨凯平,任艳军,周红莉,等.急诊重症监护病房医院感染管理的进展[J].中华医院感染学杂志,2009,19(9):1169-1170.
[24]Zubair AQ,David LP,Brian AP,et al.Treatment Outcome of Bacteremia Due to KPC-Producing Klebsiella pneumoniae:Superiority of Combination Antimicrobial Regimens[J].Antimicrobial Agents and Chemotherapy,April 2012,56(4):2108-2113.
[25]Grace CL,David SB.Treatment of Klebsiella pneumoniae Carbapenemase(KPC)infections:a review of published case series and case reports[J].Lee and BurgessAnnals of Clinical Microbiology and Antimicrobials.2012.
[26]Matthew EF,Drosos EK,Patrice Nord.Therapeutic options for infections with Enterobacteriaceae producing carbapenem-hydrolyzing enzymes[J].Future Microbiol,2011,6(6):653-666.
[27]G.Samonis,S.Maraki,D.E.Kara,et al.Synergy of fosfomycin with carbapenems,colistin,netilmicin,and tigecycline against multidrug-resistant Klebsiella pneumoniae,Escherichia coli,and Pseudomonas aeruginosa clinical isolates[J].Eur J Clin Microbiol Infect Dis,2012,3(1):695-701.