ICU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分析
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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.
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.
引文
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[28]Derbie A,Hailu D,Mekonnen D,et al.Antibiogram profile of uropathogens isolated at Bahir Dar Regional Health Research Laboratory Centre,Northwest Ethiopia[J].Pan Afr Med J,2017,10(26):134-140
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[2]Temkin E,Fallach N,Almagor J,et al.Estimating the number of infections caused by antibiotic-resistant Escherichia coli and Klebsiella pneumoniae in 2014:a modelling study[J].Lancet Glob Health,2018,6(9):e969-e979
[3]Dong N,Yang X,Zhang R,et al.Tracking microevolution events among ST11 carbapenemase-producing hypervirulent Klebsiella pneumoniae outbreak strains[J].Emerg Microbes Infect,2018,7(1):146-154
[4]Manyahi J,Moyo SJ,Tellevik MG,et al.Detection of CTX-M-15beta-lactamases in Enterobacteriaceae causing hospital-and community-acquired urinary tract infections as early as 2004,in Dar es Salaam,Tanzania[J].BMC Infect Dis,2017,17(1):282-289
[5]Looney AT,Redmond EJ,Davey NM,et al.Methicillin-resistant Staphylococcus aureus as a uropathogen in an Irish setting[J].Medicine(Baltimore),2017,96(14):e4635
[6]Oliveira-Pinto C,Diamantino C,Oliveira PL,et al.Occurrence and characterization of class 1 integrons in Escherichia coli from healthy individuals and those with urinary infection[J].J Med Microbiol,2017,66(5):577-583
[7]Ershova K,Savin I,Kurdyumova N,et al.Implementing an infection control and prevention program decreases the incidence of healthcareassociated infections and antibiotic resistance in a Russian neuro-ICU[J].Antimicrob Resist Infect Control,2018,31(7):94-105
[8]Kabugo D,Kizito S,Ashok DD,et al.Factors associated with community-acquired urinary tract infections among adults attending assessment centre,Mulago Hospital Uganda[J].Afr Health Sci,2016,16(4):1131-1142
[9]Kauf TL,Prabhu VS,Medic G,et al.Cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam as empiric therapy based on the in-vitro surveillance of bacterial isolates in the United States for the treatment of complicated urinary tract infections[J].BMC Infect Dis,2017,17(1):314-324
[10]Riu M,Chiarello P,Terradas R,et al.Incremental cost of nosocomial bacteremia according to the focus of infection and antibiotic sensitivity of the causative microorganism in a university hospital[J].Medicine(Baltimore),2017,96(17):e6645
[11]Kistler CE,Zimmerman S,Scales K,et al.The Antibiotic Prescribing Pathway for Presumed Urinary Tract Infections in Nursing Home Residents[J].J Am Geriatr Soc,2017,7(28):1111-1119
[12]Xu L,Sun X,Ma X.Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae[J].Ann Clin Microbiol Antimicrob,2017,16(1):18-30
[13]Yilema A,Moges F,Tadele S,et al.Isolation of enterococci,their antimicrobial susceptibility patterns and associated factors among patients attending at the University of Gondar Teaching Hospital[J].BMC Infect Dis,2017,17(1):276-284
[14]Wambaugh MA,Shakya VPS,Lewis AJ,et al.High-throughput identification and rational design of synergistic small-molecule pairs for combating and bypassing antibiotic resistance[J].PLoS Biol,2017,15(6):e2001644
[15]Magyar A,Koves B,Nagy K,et al.Spectrum and antibiotic resistance of uropathogens between 2004 and 2015 in a tertiary care hospital in Hungary[J].J Med Microbiol,2017,66(6):788-797
[16]Kohler P,Fulchini R,Albrich WC,et al.Antibiotic resistance in Swiss nursing homes:analysis of National Surveillance Data over an11-year period between 2007 and 2017[J].Antimicrob Resist Infect Control,2018,20(7):88-97
[17]Wangchinda W,Pati N,Maknakhon N,et al.Collateral damage of using colistin in hospitalized patients on emergence of colistinresistant Escherichia coli and Klebsiella pneumoniae colonization and infection[J].Antimicrob Resist Infect Control,2018,17(7):84-96
[18]Bag A,Chattopadhyay RR.Synergistic antibiofilm efficacy of a gallotannin 1,2,6-tri-O-galloyl-β-D-glucopyranose from Terminalia chebula fruit in combination with gentamicin and trimethoprim against multidrug resistant uropathogenic Escherichia coli biofilms[J].PLoS One,2017,12(5):e0178712
[19]Korom RR,Onguka S,Halestrap P,et al.Brief educational interventions to improve performance on novel quality metrics in ambulatory settings in Kenya:A multi-site pre-post effectiveness trial[J].PLoS One,2017,12(4):e0174566
[20]Tofte N,Nielsen AC,Trstrup H,et al.Chronic urinary tract infections in patients with spinal cord lesions-biofilm infection with need for long-term antibiotic treatment[J].APMIS,2017,125(4):385-391
[21]Bebell LM,Ngonzi J,Bazira J,et al.Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital[J].PLoS One,2017,12(4):e0175456
[22]Moghadampour M,Salari-Jazi A,Faghri J.High rate of carbapenem-resistant Klebsiella pneumoniae detected from hospital equipments in Iran[J].Acta Microbiol Immunol Hung,2018,8(16):1-10
[23]Korth J,Kukalla J,Rath PM,et al.Increased resistance of gramnegative urinary pathogens after kidney transplantation[J].BMCNephrol,2017,18(1):164-172
[24]Liu C,Shi J,Guo J.High prevalence of hypervirulent Klebsiella pneumoniae infection in the genetic background of elderly patients in two teaching hospitals in China[J].Infect Drug Resist,2018,31(11):1031-1041
[25]Kabuyaya M,Chimbari MJ,Manyangadze T,et al.Efficacy of praziquantel on Schistosoma haematobium and re-infection rates among school-going children in the Ndumo area of uMkhanyakude district,Kwa Zulu-Natal,South Africa[J].Infect Dis Poverty,2017,6(1):83-92
[26]Alfaresi M.Whole Genome Sequencing of Klebsiella pneumoniae Strain Unravels a New Model for the Development of Extensive Drug Resistance in Enterobacteriaceae[J].Open Microbiol J,2018,29(12):195-199
[27]Zhou Y,Wang T,Guo Y,et al.In Vitro/Vivo Activity of Potential MCR-1 Inhibitor in Combination With Colistin Againsts mcr-1-Positive Klebsiella pneumonia[J].Front Microbiol,2018,17(9):1615-1625
[28]Derbie A,Hailu D,Mekonnen D,et al.Antibiogram profile of uropathogens isolated at Bahir Dar Regional Health Research Laboratory Centre,Northwest Ethiopia[J].Pan Afr Med J,2017,10(26):134-140
[29]Castaldo N,Givone F,Peghin M,et al.Multidrug-resistant Pseudomonas aeruginosa skin and soft-tissue infection successfully treated with ceftolozane/tazobactam[J].J Glob Antimicrob Resist,2017,8(9):100-102
[30]Sardar A,Basireddy SR,Navaz A,et al.Comparative Evaluation of Fosfomycin Activity with other Antimicrobial Agents against E.coli Isolates from Urinary Tract Infections[J].J Clin Diagn Res,2017,11(2):26-29
[31]Bir R,Mohapatra S,Kumar A,et al.Comparative evaluation of in-house Carba NP test with other phenotypic tests for rapid detection of carbapenem-resistant Enterobacteriaceae[J].J Clin Lab Anal,2018,8(20):e22652
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