| 张琰,徐丽婷,王浩,等.耐碳青霉烯肺炎克雷伯菌对头孢他啶 /阿维巴坦的耐药情况及其危险因素分析[J].安徽医药,2023,27(10):2103-2106. |
| 耐碳青霉烯肺炎克雷伯菌对头孢他啶 /阿维巴坦的耐药情况及其危险因素分析 |
| Analysis of resistance and risk factors of carbapenem-resistant Klebsiella pneumoniae to ceftazidime/avibactam |
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| DOI：10.3969/j.issn.1009-6469.2023.10.042 |
| 中文关键词: 肺炎克雷伯菌 抗药性，细菌 耐碳青霉烯肺炎克雷伯菌 头孢他啶 阿维巴坦 危险因素 |
| 英文关键词: Klebsiella pneumoniae Drug resistance, bacterial Carbapenem-resistant Klebsiella pneumoniae Ceftazidime Avibactam Risk factors |
| 基金项目:西安国际医学中心医院院级青年课题( 2020QN022) |
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| 中文摘要: |
| 目的探讨耐碳青霉烯类肺炎克雷伯菌( CRKP)对头孢他啶 /阿维巴坦( ceftazidime/avibactam，CZA)的耐药情况及危险因素。方法选取 2019年 10月至 2022年 5月在西安国际医学中心重症监护病房( intensive care unit，ICU)住院治疗的 CRKP病人 156例，根据 CRKP病人是否对 CZA耐药分为 CZA敏感组( n=111)和耐药组( n=45)。采用微量肉汤稀释法检测 CRKP对 CZA的药敏情况。分析比较 CRKP对 CZA敏感病人和耐药病人的一般资料，多因素 logistic回归分析 CRKP对 CZA耐药的危险因素。比较两组病人住院期间的死亡率。结果 156株 CRKP中 111株( 71.15%)对 CZA敏感， 45株( 28.85%)对 CZA耐药。两组病人在年龄、性别、身体质量指数、标本来源和基础疾病上差异无统计学意义( P>0.05)。在侵入性操作中， CZA耐药组机械通气( 77.78%比 55.86%)、透析( 46.67%比 18.02%)和手术的病人( 77.78%比 54.05%)比例明显高于 CZA敏感组( P<0.05)。同时， CZA耐药组既往接受 CZA治疗的病人比例明显高于 CZA敏感组( 24.44%比 9.01%)差异有统计学意义( P<0.05)。多因素 logistic回归分析显示 CRKP对 CZA耐药的危险因素包括透析、机械通气和既往接受 CZA治，疗( P<0.05)。 CZA耐药组中病人住院期间死亡率( 28.89%)明显高于 CZA敏感组( 10.81%)差异有统计学意义( χ2=7.78，P=0.005)。结论部分 CRKP对 CZA耐药，耐药病人住院期间死亡率高。透析、机械通气和既往接，受 CZA治疗是 CRKP对 CZA耐药的危险因素。 |
| 英文摘要: |
| Objective To investigate the drug resistance and risk factors of ceftazidime/avibactam (CZA) use for carbapenem-resistant Klebsiella pneumonia (CRKP).Methods A total of 156 CRKP patients who were hospitalized in the ICU of Xi′an InternationalMedical Center Hospital from October 2019 to May 2022 were selected and divided into CZA sensitive group (n=111) and resistant group (n=45) according to whether CRKP patients were resistant to CZA. The susceptibility of CRKP to CZA was detected by micro-broth dilution method. The general data of CRKP-sensitive patients and CZA-resistant patients were analyzed and compared, and the risk factors of CRKP-resistant to CZA were analyzed by multivariate logistic regression. Mortality during hospitalization was comparedbetween the two groups. Results Among the 156 CRKP isolates, 111 isolates (71.15%) were sensitive to CZA, and 45 isolates(28.85%) were resistant to CZA. There were no significant differences in age, gender, body mass index, specimen source and underlyingdiseases between the two groups (P>0.05). In invasive procedures, the proportion of patients undergoing mechanical ventilation (77.78% vs. 55.86%), dialysis (46.67% vs.18.02%) and surgery (77.78% vs. 54.05%) in the CZA-resistant group was significantly higher than that in the CZA-sensitive group (P<0.05). The proportion of patients who received CZA treatment in the CZA-resistant group was significantly higher than that in the CZA-sensitive group (24.44% vs. 9.01%), and the difference was statistically significant (P< 0.05). Multivariate Logistic regression analysis showed that the risk factors of CRKP resistance to CZA included dialysis, mechanicalventilation and previous CZA treatment (P<0.05). The mortality rate during hospitalization in the CZA-resistant group (28.89%) was significantly higher than that in the CZA-sensitive group (10.81%), and the difference was statistically significant (χ2=7.776, P =0.005). Conclusions Some CRKPs are resistant to CZA, and the mortality of drug-resistant patients is high during hospitalization. Dialysis,mechanical ventilation, and previous CZA treatment are risk factors for CZA resistance in CRKP. |
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