肺炎克雷伯菌在呼吸机相关性肺炎中的耐药性及多重耐药危险因素的研究

Study on the resistance and risk factors of multidrug-resistant Klebsiella pneumoniae in ventilatorassociated pneumonia

关键词:  肺炎克雷伯菌  呼吸机相关性肺炎  耐药性  危险因素

Key words:  Klebsiella pneumoniae  ventilator-associated pneumonia  resistance  risk factors

摘要:

目的 探讨肺炎克雷伯菌（KP）在呼吸机相关性肺炎（VAP）中的耐药性及多重耐药的危险因素。方法 在VAP患者中分离210株非重复KP。采用微生物质谱检测系统和全自动微生物分析仪鉴定KP和检测药物敏感性。采用多因素logistic回归分析VAP患者感染多重耐药KP的危险因素。结果 多重耐药KP和耐药KP的构成比分别为35.2%和64.8%。左氧氟沙星、头孢他啶、复方新诺明、多粘菌素B、四环素在多重耐药KP组中的耐药率均明显高于耐药KP组（均P<0.01或0.05）。logistic回归分析显示，年龄≥65岁、呼吸机使用时间≥7 d、入住ICU时间≥14 d、使用抗菌药物类型≥2种、迟发型VAP、二次气管插管、白蛋白<30 g/L等的P值均<0.05或0.01。结论 KP在VAP中的耐药形势不容乐观，多重耐药KP更严峻。年龄≥65岁、呼吸机使用时间≥7 d、入住ICU时间≥14 d、使用抗菌药物类型≥2种、迟发型VAP、二次气管插管、白蛋白<30 g/L是VAP患者感染多重耐药KP的独立危险因素。

Abstract:

Objective To investigate the resistance and risk factors of multidrug-resistant Klebsiella pneumoniae (KP) in ventilator-associated pneumonia (VAP). Methods A total of 210 non repetitive KP strains were isolated from VAP patients. Identification of KP and detection of drug sensitivity were used by microbial mass spectrometry detection system and fully automated microbial analyzer. Multivariate logistic regression was used to analyze the risk factors of multi drug resistant KP infection in VAP patients. Results The proportions of multidrug-resistant KP and drug-resistant KP were 35.2% and 64.8%, respectively. The resistance rates of levofloxacin, ceftazidime, compound sulfamethoxazole, polymyxin B, and tetracycline in the multi resistant KP group were significantly higher than those in the resistant KP group (P<0.01 or 0.05). Logistic regression analysis showed that the P-values for age≥65, ventilator usage≥7 days, admission to ICU≥14 days, types of antibiotics used≥2, late onset VAP, secondary tracheal intubation, and albumin<30 g/L were all<0.05 or 0.01. Conclusion The resistance situation of KP in VAP is not optimistic, and multi resistant KP is more severe. age≥65, ventilator usage≥7 days, admission to ICU≥14 days, types of antibiotics used≥2, late onset VAP, secondary tracheal intubation, and albumin<30 g/L are independent risk factor for infection with multidrug-resistant KP in VAP patients.