摘要
[目的]探讨院内感染肺炎克雷伯菌的影响因素及耐药情况.[方法]选取2018年3月至2023年1月本院收治的87例院内感染患者作为研究对象,其中28例院内感染肺炎克雷伯菌患者纳入观察组,59例院内感染鲍曼不动杆菌的患者纳入对照组.比较两组一般资料;分析菌株来源、耐药性及毒力基因;分析院内感染肺炎克雷伯菌的影响因素及耐药情况.[结果]观察组中有21例(75.00％)为混合感染阳性,其中A型(肺炎链球菌)5例(23.81％)、B型(葡萄球菌)4例(19.05％)、C型(流感嗜血杆菌)2例(9.52％)、A型+B型4例(19.05％)、A型+C型2例(9.52％)、B型+C型3例(14.29％)、A型+B型+C型1例(4.76％).对照组中有26例(44.07％)为混合感染阳性,其中 A 型 6 例(23.08％)、B 型 5 例(19.23％)、C 型 4 例(15.38％)、A 型+B 型 3 例(8.69％)、A 型+C 型 3 例(11.54％)、B型+C型4例(15.38％)、A型+B型+C型1例(3.85％).两组年龄、性别、住院时间、白蛋白、科室分布、白细胞(WBC)计数及留置导管、侵入性操作、与感染患者住通病区≥1周、终末消毒残缺占比比较,差异无统计学意义(P＞0.05);观察组长期使用广谱抗菌药物、合并其他细菌感染≥2种及前期肺炎克雷伯菌定植占比高于对照组(P＜0.05).Logistic回归分析结果:长期使用广谱抗菌药物、合并其他细菌感染≥2种、前期肺炎克雷伯菌定植是患者院内感染肺炎克雷伯菌的危险因素(P＜0.05).28株菌株主要来源于痰液、血液;肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢曲松耐药性最高(100％),肺炎克雷伯菌对替加环素(3.57％)、四环素(7.14％)耐药性最低;28株菌株中高黏液性菌株6株(21.43％)、非高黏液性菌株22株(78.57％),高黏液性菌株拉丝实验阳性率高于非黏液性菌株(P＜0.05);高黏液性菌株iroN、rmpA及ybtS毒力基因阳性率高于非黏液性菌株(P＜0.05).[结论]长期使用广谱抗菌药物、合并其他细菌感染≥2种、前期肺炎克雷伯菌定植是患者院内感染肺炎克雷伯菌的危险因素,肺炎克雷伯菌对常见抗菌药物耐药性较为严重.
Abstract
[Objective]To explore the influencing factors and drug resistance of Klebsiella pneumoniae in hospi-tal acquired infections.[Methods]A total of 87 patients with hospital acquired infections admitted to our hospital from March 2018 to January 2023 were selected as the study subjects.Among them,28 patients with hospital ac-quired infections of Klebsiella pneumoniae were included in the observation group,and 59 patients with hospital ac-quired infections of Acinetobacter baumannii were included in the control group.Two sets of general information were compared;Strain source,drug resistance,and virulence genes;The influencing factors and drug resistance of Klebsiella pneumoniae infection in the hospital were analyzed.[Results]In the observation group,21 cases(75.00％)were positive for mixed infections,including 5 cases(23.81％)of type A(Streptococcus pneumoniae),4 cases(19.05％)of type B(Staphylococcus aureus),2 cases(9.52％)of type C(Haemophilus influenzae),4 cases(19.05％)of type A+B,2 cases(9.52％)of type A+C,3 cases(14.29％)of type B+C,and 1 case(4.76％)of type A+B+C.In the control group,26 cases(44.07％)were positive for mixed infections,including 6 cases of type A(23.08％),5 cases of type B(19.23％),4 cases of type C(15.38％),3 cases of type A+B(8.69％),3 ca-ses of type A+C(11.54％),4 cases of type B+C(15.38％),and 1 case of type A+B+C(3.85％).There was no statistically significant difference(P＞0.05)in age,gender,length of hospital stay,albumin levels,department distribution,white blood cell count(WBC)and indwelling catheter count,invasive procedures,and the proportion of infected patients staying in the same ward for ≥ 1 week or with incomplete final disinfection between the two groups;The observation group had a higher proportion of long-term use of broad-spectrum antibiotics,combined with at least 2 other bacterial infections,and early colonization of Klebsiella pneumoniae than the control group(P＜0.05).The results of logistic regression analysis showed that long-term use of broad-spectrum antibiotics,concur-rent infection with ≥2 other bacteria,and early colonization of Klebsiella pneumoniae were risk factors for hospital acquired Klebsiella pneumoniae infection in patients(P＜0.05).28 strains of bacteria mainly come from sputum and blood;Klebsiella pneumoniae has the highest resistance to piperacillin/tazobactam and ceftriaxone(100％),while it has the lowest resistance to tigecycline(3.57％)and tetracycline(7.14％);Among the 28 strains,6 strains(21.43％)were high mucinous and 22 strains(78.57％)were non high mucinous.The positive rate of high mucin-ous strains in the wire drawing test was higher than that of non mucinous strains(P＜0.05);The positive rates of virulence genes iroN,rmpA,and ybtS in high mucinous strains were higher than those in non mucinous strains(P＜0.05).[Conclusion]Long term use of broad-spectrum antibiotics,combined with at least 2 other bacterial infec-tions,and early colonization of Klebsiella pneumoniae are risk factors for patients to be infected with Klebsiella pneumoniae.Klebsiella pneumoniae is more resistant to common antibiotics.
维普
万方数据