【作者】 刘敏； 徐萍； 杨婉花； 何娟；

【Author】 LIU Min;Xu Ping;Yang Wan-Hua;HE Juan;Department of pharmacy,The Fifty Centry Hospital of Tianjin;Department of pharmacy,Ruijin Hospital,Shanghai Jiaotong University School of Medicine;

【机构】 天津市第五中心医院药剂科； 上海交通大学医学院附属瑞金医院药剂科；

【摘要】 目的:研究碳青霉烯类耐药的肺炎克雷伯菌(Carbapenem-resistant Klebsiella pneumoniae,CRKP)感染患者的治疗效果,并对疗效的影响因素进行分析,为优化临床治疗方案提供参考。方法:2009年12月~2013年11月某三甲医院不同病区患者住院治疗期间分离和培养得到CRKP,确诊为感染的病例共91例纳入本研究。收集患者的临床资料,并随访患者的抗感染治疗效果。分别采用单因素分析方法和多元1ogistic回归方法分析患者抗感染治疗效果的影响因素。结果:91例患者经治疗后,治愈26例(28.57%),好转38例(41.76%),无效27例(29.67%);单因素分析显示:入院前90天内住院史、感染类型、机械通气时间、合并其他细菌感染、合并真菌感染、病原学分离和培养阳性后的首选治疗方案对患者治疗的总体有效率有影响(P<0.05或P<0.01),入院前90天内住院史、感染类型、机械通气时间、合并其他细菌感染对治愈率有影响(P<0.05或P<0.01);多元logistic回归分析显示,各因素对患者总体有效率无影响;而入院前90天内住院史、机械通气对治愈率有影响。结论:CRKP感染患者临床预后较差。应严格控制临床抗菌药物的使用,减少CRKP的出现,对改善CRKP感染患者临床预后有益。入院前90天内是否有住院史、机械通气对患者的临床预后有影响,制定抗感染治疗方案时应充分考虑。更多还原

【Abstract】 Objective To investigate the clinical efficacy in the patients infected by Carbapenem-resistant Klebsiella Pneumonia in our hospital,and analyze the influencing factor to the clinical efficacy,and to provide the valuable references for the clinical treatment.Methods A total of 91 patients with nosocomial infection,in which Carbapenem-resistant Klebsiella Pneumonia was separated and cultivated,were included in the different endemic area in our hospital in Dec,2011- Nov,2013.The general clinical data of each case were collected,and the anti-infective therapy effect of each case was followed up.The influencing factors to the clinical efficacy were analyzed by single-factor analysis and multivariate logistic regression analysis.Results There are 26 cases(28.57%) with cured effect,38 cases(41.76%) with improved effect,and 27 cases(29.67%) with null effect;The results of single-factor analysis shows that hospitalization in 90 days before CRKP virus isolation and culture positive,the type of infection,duration of mechanical ventilation,.combined with fungal infection,first treatment after pathogen isolation and culture positive had the effect on the Overall efficiency(P<0.05 or P<0.01),the others have no effect on the Overall efficiency(P>0.05);and hospitalization in 90 days before CRKP virus isolation and culture positive.the type of infection,duration of mechanical ventilation and combined with other bacterial infections had the effect on the cure rate(P<0.05 or PO.01),the others have no effect on the cure rate(P>0.05);Multivariate logistic regression analysis results show that all factors had no effect on the Overall efficiency(P>0.05),hospitalization in 90 days before CRKP virus isolation and culture positive,duration of mechanical ventilation had the effect on the cure rate(P<0.05 or P<0.01).Conclusions The clinical efficacy in the patients infected by Carbapenem-resistant Klebsiella Pneumonia was poor.It is better to improve the clinical efficacy in the patients infected by Carbapenem-resistant Klebsiella Pneumonia to use antibacterial drugs strictly in clinic and reduce the appearance of Carbapenem-resistant Klebsiella Pneumonia.The hospital stay history,hospital stay with positive etiology and the antibiotic resistance condition had the effect on the clinical efficacy,which should be considered when the antibacterial treatment progress is decided.更多还原