Candevir Ulu Aslıhan, Kurtaran Behice, Inal Ayşe Seza, Kömür Süheyla, Kibar Filiz, Yapıcı Çiçekdemir Hatice, Bozkurt Seval, Gürel Derya, Kılıç Fatma, Yaman Akgün, Aksu Hasan Salih Zeki, Taşova Yeşim
Department of Infectious Diseases, Çukurova University, Adana, Turkey.
Department of Infectious, Çukurova University, Adana, Turkey.
Med Sci Monit. 2015 Jan 17;21:219-24. doi: 10.12659/MSM.892516.
Nosocomial infections caused by Carbapenem-resistant Klebsiella pneumoniae (CRKP) are increasing. Our aim in this study was to investigate the risk factors of CRKP infections.
MATERIAL/METHODS: A retrospective cohort study was performed between 1 January and 31 December 2012 in ICU patients. Data was taken from the hospital infection control database for CRKP. The clinical samples collected from the patients were tested by an automatized system and disk diffusion. SPSS software v11.5 was used for statistical analysis.
Totally, 105 Klebsiella pneumoniae isolates were found in 2012 and the carbapenem resistance rate was 48%. The first episode of infection was taken into risk factor analysis. Of the 98 patients, 61 (62.2%) were male and the mean and median ages were 30.4±29.8 and 25 (0-93). The length of stay was longer in the resistant group (p=0.026). Mortality was 48% in the whole group and similar between groups (p=0.533). There was a relationship between meropenem and third-generation cephalosporin use and resistance (OR 3.244 (1.193-8.819) and OR: 3.590 (1.056-12.209). The other risk factors in univariate analysis were: Immunosuppression OR: 2.186 (1.754-2.724), nasogastric catheter OR: 3.562 (1.317-9.634), peripheral arterial catheter OR: 2.545 (1.027-6.307), and being admitted to the neurosurgical unit OR: 4.324 (1.110-16.842).
Restriction of third-generation cephalosporin and carbapenem use and invasive procedures, along with infection control precautions and disinfection policies, may be effective in reducing the carbapenem resistance in ICUs.
耐碳青霉烯类肺炎克雷伯菌（CRKP）引起的医院感染正在增加。本研究的目的是调查CRKP感染的危险因素。
材料/方法：于2012年1月1日至12月31日对ICU患者进行了一项回顾性队列研究。数据取自医院感染控制数据库中关于CRKP的资料。从患者采集的临床样本通过自动化系统和纸片扩散法进行检测。使用SPSS 11.5软件进行统计分析。
2012年共发现105株肺炎克雷伯菌分离株，碳青霉烯耐药率为48%。将首次感染事件纳入危险因素分析。98例患者中，61例（62.2%）为男性，平均年龄和中位数年龄分别为30.4±29.8岁和25岁（0 - 93岁）。耐药组的住院时间更长（p = 0.026）。全组死亡率为48%，组间相似（p = 0.533）。美罗培南和第三代头孢菌素的使用与耐药之间存在关联（比值比3.244（1.193 - 8.819）和比值比：3.590（1.056 - 12.209）。单因素分析中的其他危险因素为：免疫抑制，比值比：2.186（1.754 - 2.724）；鼻胃管，比值比：3.562（1.317 - 9.634）；外周动脉导管，比值比：2.545（1.027 - 6.307）；入住神经外科病房，比值比：4.324（1.110 - 16.842）。
限制第三代头孢菌素和碳青霉烯的使用以及侵入性操作，同时采取感染控制预防措施和消毒政策，可能对降低ICU中的碳青霉烯耐药性有效。
