中国临床医学2026，Vol.33Issue(2)：293-298,6.DOI:10.12025/j.issn.1008-6358.2026.20251409
ICU重症肺炎患者耐碳青霉烯类肺炎克雷伯菌与产超广谱β内酰胺酶大肠埃希菌感染耐药性及危险因素
Analysis of drug resistance and infection-related risk factors of carbapenem-resistant Klebsiella pneumoniae and extended-spectrum β-lactamase-producing Escherichia coli in patients with severe pneumonia in ICU
摘要
Abstract
Objective To analyze the rates of drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP)and extended-spectrum β-lactamase-producing Escherichia coli(ESBL-E.coli)in bronchoalveolar lavage fluid(BALF)of critically ill patients with severe pneumonia and artificial airway and risk factors of CRKP.Methods Patients with severe pneumonia and artificial airway treated in the Center of Emergency and Intensive Care Unit,Jinshan Hospital,Fudan University from May 2022 to May 2025 were selected.Klebsiella pneumoniae(K.pneumoniae)and Escherichia coli(E.coli)isolated and cultured from BALF of these patients were analyzed.The drug resistance rates of the two bacteria were compared.The multivariate logistic regression was used to analyze related risk factors for CRKP infection.Results A total of 384 patients were included,and 384 strains were cultured,including 330 strains(85.9%)of K.pneumoniae and 54 strains(14.1%)of E.coli.The infection rate of K.pneumoniae was higher.Compared with E.coli,the drug-resistant gene expression rate of K.pneumoniae was lower(37.3%vs 57.4%,P＜0.01).The resistance rates of CRKP to cefotaxime,cefepime,aztreonam,and imipenem were higher than those of ESBL-E.coli(P＜0.003).Both CRKP and ESBL-E.coli had high sensitivity to polymyxin and tigecycline.Multivariate logistic regression showed duration of mechanical ventilation≥7 days,and combination of≥2 antibiotics for over 7 days were independent risk factors for CRKP infection(P＜0.01).Conclusions For patients with severe pneumonia and artificial airway in ICU,K.pneumoniae is the main bacterial infection.CRKP and ESBL-E.coli in BALF exhibit different degrees of drug resistance to various antibacterial agents,both have the characteristic of multidrug resistance,and are sensitive to polymyxin and tigecycline.Prevention and control of risk factors related to CRKP should be formulated particularly.关键词
耐碳青霉烯类肺炎克雷伯菌/产超广谱β内酰胺酶大肠埃希菌/支气管肺泡灌洗液/人工气道/耐药性Key words
carbapenem-resistant Klebsiella pneumoniae/extended-spectrum β-lactamase-producing Escherichia coli/bronchoalveolar lavage fluid/artificial airway/drug resistance分类
医药卫生引用本文复制引用
张宝成,刁胜安,申捷,邵义如..ICU重症肺炎患者耐碳青霉烯类肺炎克雷伯菌与产超广谱β内酰胺酶大肠埃希菌感染耐药性及危险因素[J].中国临床医学,2026,33(2):293-298,6.基金项目
上海市金山区科学技术创新资金项目(2019-3-07).Supported by Shanghai Jinshan District Science and Technology Commission(2019-3-07). （2019-3-07）
