摘要
目的了解ICU耐碳青霉烯类肺炎克雷伯菌感染患者的预后并加以分析,为临床治疗提供可靠依据。方法收集2009年1-12月浙江大学医学院附属第二医院中心ICU经细菌培养鉴定为肺炎克雷伯菌菌株82株,采用法国生物梅里埃公司的VITEK系统进行细菌鉴定,用琼脂稀释法进行药物敏感性试验;将肺炎克雷伯菌医院感染患者47例经药敏试验分耐碳青霉烯类患者组和非耐药组,对两组患者的病死率、入住ICU天数、使用呼吸机天数进行分析。结果从痰中分离肺炎克雷伯菌菌株居首位,占54.88%,其余依次为引流液19.51%、血液15.85%、胆汁3.66%、伤口分泌物2.44%、深静脉导管尖端2.44%、穿刺液1.22%;肺炎克雷伯菌对美罗培南、亚胺培南的耐药率分别为54.88%、52.44%;与非耐药组比较,耐碳青霉烯类肺炎克雷伯菌感染患者的预后差、病死率高,达到76.19%,差异有统计学意义(P<0.05);患者入住ICU天数延长(74.14±64.23)d,差异有统计学意义(P<0.05);呼吸机使用天数延长(61.8±73.68)d,差异有统计学意义(P<0.05)。结论 ICU中耐青霉烯类肺炎克雷伯菌感染患者的预后差,病死率高,入住ICU天数及呼吸机使用天数明显延长;严格控制抗菌药物药物的使用,及时有效地细菌鉴定及药物敏感试验,尽早发现肺炎克雷伯菌的感染情况,为临床提供可靠的治疗依据。
OBJECTIVE To understand and analyze the prognosis of patients infected by carbapenem-resistant Kleb- siella pneumoniae （CRKP） in ICU so as to provide a reliable basis for clinical treatment. METHODS A total of 82 strains of K. pneumoniae were identified and their source distribution was analyzed. These strains were derived from bacterial cultures collected in ICU of the Second Affiliated Hospital, College of Medicine, Zhejiang University between Jan and Dec 2009; the identification of bacteria was completed by using VITEK 2 systems of Institute Merieux, France. The drug susceptibility testing was carried out using agar dilution methods 47 patients infected by CRKP were divided into carbapenem-resistant patient group and non-carbapenem-resistant patient group. For both groups, the fatality rate, ICU stay, and the duration of use of ventilator were analyzed. RESULTS The K. pneumoniae strains derived from the sputum were the predominant, accounting for 54.88% of the total number, followed by the drainage fluid （19.51%）, blood （15.85%）, bile（3.66%）, wound secretion（2.44%）, the tip of deep vein vessel （2.44%）, and puncture fluid （1.22%）. The resistant rates of K. pneumoniae to meropenem and imipenem were 54. 88% and 52. 44%, respectively. As compared with the non carbapenem-resistant patient group, the prognosis of the patients with CRKP infection was poor, and the fatality rate was high, reaching up to 76.19 % ; the difference was statistically significant （P〈0.05）, the duration of ICU stay extended by （74.14±64.23）days, the difference was statistically significant （P〈0. 05）; the duration of use of ventilator extended by （61.8±73.68） days, the difference was statistically significant （P〈0.05）. CONCLUSION For patients infected by CRKP in ICU, the prognosis is poor, the fatality rate is high, the duration of the ICU stay and the duration of use of ventilator have been prolonged. To perform an effective bacterial identification and drug susceptibility testing in a timely manner and detect the K. pneumoniae infection in the early stage can provide reliable basis for the clinical treatment.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第2期283-285,共3页
Chinese Journal of Nosocomiology
关键词
肺炎克雷伯菌
耐药性
碳青霉烯类
Klebsiella pneumoniae
Drug resistance
Carbapenems
