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目的 调查肺炎克雷伯菌在不同感染类型中的临床分布特点，分析碳青霉烯耐药肺炎克雷伯菌（CRKP）感染的危险因素。方法 对1 651例肺炎克雷伯菌病例中检出的307例CRKP进行回顾性分析，采用单因素及多因素Logistic回归分析CRKP感染的危险因素。结果 肺炎克雷伯菌主要分布科室为神经外科、重症医学科、新生儿/儿科以及呼吸内科，主要感染部位为呼吸道、泌尿系统以及血流。CRKP感染的危险因素有高血压、慢性阻塞性肺疾病、有创操作、使用免疫抑制剂、抗菌药物暴露史、感染前90 d内入住重症监护室、使用质子泵抑制剂。多因素Logistic回归分析结果表明，高血压、侵入性操作、使用免疫抑制剂、抗菌药物暴露史、感染前90 d内入住重症监护室是CRKP感染的危险因素。结论 应对有CRKP感染危险因素的患者进行主动监测，对携带CRKP患者及时隔离，加强环境清洁消毒，规范抗菌药物以及免疫抑制剂的临床应用，尽量取消不必要的侵入性操作，减少CRKP院内感染的发生。
Abstract：AIM To analyze the clinical distribution characteristics of Klebsiella pneumoniae in different infection types, as well as risk factors for carbapenem-resistant Klebsiella Pneumoniae(CRKP) infection. METHODS Retrospectively analyze 1 651 cases of Klebsiella pneumoniae, including 307 cases of CRKP in the hospital. Single-factor and multi-factor Logistic regression analyses were employed to identify the risk factors for CRKP infection.RESULTS The main distribution departments of Klebsiella pneumoniae were neurosurgery department, intensive care uni(ICU), department of pediatrics and respiratory medicine, and the main infection positions were respiratory infections,urinary tract infection and bloodstream infection. High-risk factors leading to CRKP infection were hypertension,chronic obstructive pulmonary disease(COPD), invasive operation, use of immunosuppressants, exposure history of antibacterial drugs, admission of patients to ICU within 90 days before infection and use of proton pump inhibitors.Through multivariate Logistic regression analysis and ROC curve analysis, the results showed that hypertension, invasive operation, immunosuppressant, exposure history of antibacterial drugs and hospitalization in ICU within 90 days before infection were independent risk factors for CRKP infection. CONCLUSION Patients with risk of infection with CRKP should be actively monitored. Timely isolation of patients carrying CRKP, strict adherence to hand hygiene practices,enhanced environmental cleaning and disinfection, and the standardized clinical application of antimicrobial drugs and immunosuppressants are recommended. Efforts should be made to minimize unnecessary invasive procedures to reduce the occurrence of CRKP nosocomial infections.
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基本信息:
DOI：10.19577/j.1007-4406.2023.10.002
中图分类号:R446.5
引用信息:
[1]尚家磊,舒福杉,丁元波,等.耐碳青霉烯肺炎克雷伯菌感染的危险因素分析[J].中国临床药学杂志,2023,32(10):728-733.DOI:10.19577/j.1007-4406.2023.10.002.
基金信息:
黔西南州科学技术局2021年州级项目（编号2021-2-54）
2023-10-25
2023-10-25