A case of complex multi-site CRKP infection detection and treatment strategy analysis
Objective To explore the in vitro drug sensitivity test and clinical precise treatment scheme of patients with carbapenem-resistant Klebsiella pneumoniae(CRKP)infection,and to provide reference for the prevention and control management of multidrug-resistant bacteria.Methods The results of single and combined drug sensitivity tests and treatment strategies of a ICU patient with multi-site CRKP infection in 2017 were retrospectively analyzed.Three strains of different parts of the case were resuscitated.VITEK-2 compact automatic microbial identification and drug sensitivity analysis system and Kirby-Bauer(K-B)method were used to test the drug sensitivity of 33 kinds of antibiotics,and GeneXpert® Carba-R was used to detect the drug resistance gene.Results In vitro drug sensitivity test showed that the patients were resistant to conventional Enterobacteriaceae antibiotics,sensitive to tigecycline and fosfomycin,and showed a synergistic effect.The treatment plan of this patient was adjusted to the combination of tigecycline and fosfomycin.The results of drug sensitivity after resuscitation showed that only tigecycline,colistin,fosfomycin and ceftazidime/avibactam were sensitive to 33 kinds of antibiotics,and the three strains were all KPC type by gene detection.Conclusion Tigecycline combined with fosfomycin has a good treatment effect,the patient improved.KPC type accounted for the majority in the detection of adult CRKP,when the gene was not detected,new β-lactamase inhibitor compound preparations such as ceftazidime/avibactam could be preferred in clinical practice,if there was CRKP resistant to such new compound preparations and other antibiotics,combined drug sensitivity test should be added to guide clinical combined medication.
万方数据
维普
