上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (7): 973-.doi: 10.3969/j.issn.1674-8115.2017.07.016

• 论著（临床研究） • 上一篇    下一篇

多重耐药肺炎克雷伯菌感染的危险因素及治疗方案比较

刘洋 1，郑丹丹 2，韩逸超 2，史玮炀 2，戴尔宽 2，李敏 1，郑冰 1   

  1. 上海交通大学  医学院附属仁济医院检验科，上海 200127
  • 出版日期:2017-07-28 发布日期:2017-08-25
  • 通讯作者: ?郑冰，电子信箱：85750524@qq.com
  • 作者简介:刘洋（1994—），男，本科生；电子信箱：541909941@qq.com
  • 基金资助:
    上海青年临床医技人才培养资助计划（沪医卫基 [2016]05 号）

High-risk factors of infection of multidrug resistance Klebsiella pneumonia and analysis of therapeutic effects#br#

LIU Yang1, ZHENG Dan-dan2, HAN Yi-chao2, SHI Wei-yang2, DAI Er-kuan2, LI Min1, ZHENG Bing1   

  1. Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2017-07-28 Published:2017-08-25
  • Supported by:
    Shanghai Youth Clinical Medical Staff Training Program, [2016] 05

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摘要： 目的 · 分析多重耐药肺炎克雷伯菌（MDR-Kpn）感染的高危因素及不同治疗方案的疗效差异。方法 · 收集并分离医院内 110 株 MDR-Kpn，进行药敏试验。通过查询电子病历系统，51 例患者为MDR-Kpn 感染组；同病区相同基础疾病且分离到Kpn 的 51 例 患者作为对照组。对 MDR-Kpn 感染和对照组患者共 39 项临床指标进行单因素分析，对有统计学意义的变量进行多因素 Logistic 回归 分析。将感染组患者，按治疗结局分为治疗无效组和有效组，比较抗生素使用时间。结果 · 药敏试验结果显示：110 株 MDR-Kpn 对磺 胺类、磷霉素和阿米卡星的敏感性较高。单因素分析结果显示：输血、有创通气、吸痰等 12 个临床指标为感染高危因素（P<0.05）。 有效组（28 例）和无效组（23 例）在抗生素的使用时间上比较，碳青霉烯类的差异有统计学意义（P=0.025）。 结论 · 控制和消除高 危因素对预防及减少 MDR-Kpn 的感染生长有积极意义；合理使用碳青霉烯类抗生素对预后有利。

关键词: 多重耐药肺炎克雷伯菌, 感染高危因素, 耐药性, 治疗方案

Abstract:

Objective · To analyze high-risk factors of infection of multidrug resistance Klebsiella pneumonia (MDR-Kpn) and difference of therapeutic effects for different treatments.  Methods · One hundred and ten MDR-Kpn strains were collected from a hospital. K-B slip diffusion method was utilized to detect the drug susceptibility of all the strains. Based on electronic medical records system, MDR-Kpn infected group included 51 patients and control group was picked out, including 51 patients as well (by1:1 ratio basing on the infected group according to the rules of under the same department, similar basic disease and all the patients in the control group isolated with the strain of Kpn). Thirty-nine clinical information of MDR-Kpn infected and control groups are collected to make single-factor analysis of high risk factors of the infection with MDR-Kpn. Multi-factor analysis was utilized between MDRKpn infected and control groups. The lasting time of different antibiotics used in MDR-Kpn infected patients were made statistics between effective and inefficacy patients.  Results · Drug susceptibility test showed that sulfonamide, phosphonomycin and amikacin, were the three most sensitive antibiotics for 110 MDR-Kpn strains. 12 clinical information, such as blood transfusion、sputum suction、invasive ventilation were all high-risk factors for the infection of MDR-Kpn (P<0.05). The lasting time during with carbapenems (P=0.025) was statistically different between effective (n=28)and noneffective group (n=23) of MDR-Kpn infection patients.  Conclusion · Controlling and eliminating high-risk factors do help to protect and decrease the infection of MDR-Kpn. Using carbapenems correctly has great influence on prognosis.

Key words:  multidrug resistance Klebsiella pneumonia, high-risk factors, drug resistance, therapeutic schemes