Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China.
Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China.
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中国东部地区耐碳青霉烯类肺炎克雷伯菌感染的分子流行病学及危险因素
DOI：
10.3389/fmicb.2017.01061
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发表时间：
2017
影响因子：
5.2
通讯作者：
Li M
中科院分区：
文献类型：
--
作者：
Zheng B;Dai Y;Liu Y;Shi W;Dai E;Han Y;Zheng D;Yu Y;Li M
背景：碳青霉烯类耐药肺炎克雷伯菌（CRKP）的流行率不断增加，对全球治疗构成直接威胁。这项回顾性研究评估了分子流行病学，并确定了中国上海一家综合性教学医院CRKP感染的危险因素和结局。方法：从2013年1月至2015年7月，收集了从住院患者中分离的100株连续的CRKP分离株。通过聚合酶链反应筛选分离株的抗生素耐药基因，并通过脉冲场凝胶电泳（PFGE）进行分子分型。感染CRKP的患者构成病例组，并与感染碳青霉烯类敏感肺炎克雷伯菌的对照组患者进行比较。比较CRKP感染组的疗效。结果如下：在100株CRKP分离株中，多重耐药、广泛耐药（XDR）和泛耐药的比例分别为50.0%、50.0%和0%。所有CRKP分离株均产生KPC-2，可分为18个PFGE簇（A-O）和70个亚型。使用80%相似性的截止值，未检测到医院内的主要PFGE类型。CRKP感染与定植的比例为51：49。与CRKP感染相关的危险因素包括肺部疾病（p = 0.038），入住ICU（p = 0.002），有创通气（p = 0.009），输血（p = 0.028），肠外营养（p = 0.004），吸痰（p = 0.006），既往住院病史（p = 0.022），感染前90天暴露于抗生素（p = 0.030），以及住院期间的抗生素暴露，包括碳青霉烯类（p = 0.013）、酶抑制剂（p = 0.021）、硝基咪唑类（p = 0.029）和糖肽类（p = 0.000）。多变量分析显示吸痰（比值比3.090，95%置信区间1.004-9.518，p = 0.049）是CRKP感染的独立危险因素。碳青霉烯类抗生素疗程较长的CRKP感染患者（p = 0.002）的结局较好。结论：本研究显示了中国东部地区CRKP感染的严重程度。吸痰是CRKP感染的独立危险因素。延长碳青霉烯类抗生素治疗时间对CRKP感染患者有益。
Background: The increasing prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses an immediate threat to treatment worldwide. This retrospective study assessed the molecular epidemiology and determined the risk factors for and outcomes of CRKP infections in a general teaching hospital in Shanghai, China. Methods: From January 2013 to July 2015, 100 consecutive unique CRKP isolates isolated from hospitalized patients were collected. Isolates were screened for antibiotic resistance genes by polymerase chain reaction and molecular typing was performed by pulsed-field gel electrophoresis (PFGE). Patients infected with CRKP comprised the case group and were compared to the control group of patients infected with carbapenem-susceptible Klebsiella pneumoniae. Therapeutic effects were compared in the CRKP infection group. Results: Among the 100 CRKP isolates, the percentages of multidrug-resistant, extensively drug-resistant (XDR), and pandrug-resistant were 50.0, 50.0, and 0%, respectively. All the CRKP isolates produced KPC-2 and could be divided into 18 PFGE clusters (A–O) and 70 subtypes. No dominant intra-hospital PFGE type was detected using a cutoff of 80% similarity. The ratio of CRKP infection to colonization was 51 to 49. Risk factors correlated with CRKP infection included pulmonary disease (p = 0.038), ICU stay (p = 0.002), invasive ventilation (p = 0.009), blood transfusion (p = 0.028), parenteral nutrition (p = 0.004), sputum suction (p = 0.006), medical history of previous hospitalization (p = 0.022), exposure to antibiotics 90 days before infection (p = 0.030), and antibiotic exposure during hospital stay including carbapenems (p = 0.013), enzyme inhibitors (p = 0.021), nitroimidazoles (p = 0.029), and glycopeptides (p = 0.000). Multivariable analysis showed that sputum suction (odds ratio 3.090, 95% confidence intervals 1.004–9.518, p = 0.049) was an independent risk factor for CRKP infections. Patients infected with CRKP with longer carbapenems treatment course (p = 0.002) showed better outcome. Conclusion: This study showed the severity of CRKP infection in eastern China. Sputum suction was an independent risk factor for CRKP infection. Prolonged duration of treatment with carbapenems benefited the patients infected with CRKP.