呼吸道感染患者多重耐药菌肺炎克雷伯菌的耐药及危险因素分析

摘要 目的：探讨与分析呼吸道感染患者多重耐药菌肺炎克雷伯菌的耐药及危险因素。方法：选择2015年1月到2020年2月本院诊治的呼吸道感染患者65例作为研究对象，收集患者的临床样本进行细菌分离与耐药分析，调查患者的临床资料并进行危险因素分析。结果：在呼吸道感染患者65例中，分离出多重耐药菌肺炎克雷伯菌32株，占比49.2 %，其中下呼吸道、上呼吸道、灌洗液、血液标本分别占50.0 %、9.4 %、25.0 %、6.3 %。32株多重耐药菌肺炎克雷伯菌对头孢曲松、头孢呋辛、氨苄西林、头孢吡肟、头孢噻肟的耐药率分别为71.9 %、87.5 %、96.9 %、84.4 %、81.3 %，对阿米卡星、头孢替坦、左氧氟沙星、亚胺培南、环丙沙星的敏感率分别为59.4 %、68.8 %、81.3 %、75.0 %、81.3 %。非条件 Logistic回归分析显示血型A型、碳青霉烯类抗菌药物使用、引流、机械通气、糖尿病等为导致多重耐药菌肺炎克雷伯菌感染的独立危险因素(P<0.05)。结论：多重耐药菌肺炎克雷伯菌感染在呼吸道感染患者中比较常见，对头孢呋辛、氨苄西林的耐药率比较高，对左氧氟沙星、环丙沙星的敏感率比较高，血型A型、碳青霉烯类抗菌药物使用、引流、机械通气、糖尿病等为导致多重耐药菌肺炎克雷伯菌感染的独立危险因素。

Analysis of Drug Resistance and Risk Factors of Multidrug Resistant Bacteria Klebsiella Pneumonia in Patients with Respiratory Rract Infection

ABSTRACT Objective: To explore and analysis the drug resistance and risk factors of multidrug resistant bacteria Klebsiella pneumoniae in patients with respiratory tract infections. Methods: From January 2015 to February 2020, 65 cases of patients with respiratory tract infection who were admitted to the Department of Respiratory Medicine of our hospital were selected as the research objects. Clinical samples of the patients were collected for bacterial isolation and drug resistance analysis, and the clinical data of the patients were investigated and the risk factors were analyzed. Results: There were 32 strains of multi-drug resistant bacteria Klebsiella pneumoniae were isolated in the 65 patients, accounted for 49.2 %, of which the lower respiratory tract, upper respiratory tract, lavage fluid, and blood samples accounted for 50.0 %, 9.4 %, 25.0 %, 6.3 %. The resistance rates of 32 strains of multi-drug resistant bacteria Klebsiella pneumoniae to ceftriaxone, cefuroxime, ampicillin, cefepime, and cefotaxime were 71.9%, 87.5%, 96.9%, 84.4%, and 81.3%, respectively. The sensitivity rates to amikacin, cefotetan, levofloxacin, imipenem, and ciprofloxacin were 59.4 %, 68.8 %, 81.3 %, 75.0 %, and 81.3 %, respectively. Non-conditional logistic regression analysis showed that blood type A, carbapenem antibacterial drug use, drainage, mechanical ventilation, diabetes, etc. were independent risk factors for multidrug-resistant bacteria Klebsiella pneumoniae infection(P<0.05). Conclusion: Multi-drug resistant bacteria Klebsiella pneumoniae infection are more common in patients with respiratory tract infections. The drug resistance rate to Cefuroxime and ampicillin are relatively high, and the sensitivity rate to Levofloxacin and ciprofloxacin are relatively high. Blood type A Type, carbapenem antibacterial drug use, drainage, mechanical ventilation, diabetes, etc. are independent risk factors lead to multi-drug resistant bacteria Klebsiella pneumoniae infection.