耐碳青霉烯類(lèi)肺炎克雷伯菌相關(guān)危險(xiǎn)因素及防治研究進(jìn)展
發(fā)布時(shí)間:2018-06-23 來(lái)源: 美文摘抄 點(diǎn)擊:
[摘要] 碳青霉烯類(lèi)藥物的不合理使用,導(dǎo)致碳青霉烯類(lèi)藥物耐藥的菌株數(shù)量激增。碳青霉烯類(lèi)耐藥菌株中,耐碳青霉烯類(lèi)肺炎克雷伯菌占據(jù)重要比例。耐碳青霉烯類(lèi)肺炎克雷伯桿菌自1997年被首次報(bào)道后,至今在全球多個(gè)國(guó)家均有報(bào)道,有些地區(qū)甚至出現(xiàn)了暴發(fā)流行。對(duì)比前幾年細(xì)菌耐藥監(jiān)測(cè)數(shù)據(jù),我國(guó)耐碳青霉烯類(lèi)肺炎克雷伯桿菌的檢出率呈不斷上升趨勢(shì)。耐碳青霉烯類(lèi)肺炎克雷伯菌與碳青霉烯類(lèi)敏感肺炎克雷伯菌相比,具有更高的致死率。本文就流行病學(xué)現(xiàn)狀、相關(guān)危險(xiǎn)因素、防治措施方面對(duì)耐碳青霉烯類(lèi)肺炎克雷伯菌的研究進(jìn)展進(jìn)行綜述。
[關(guān)鍵詞] 肺炎克雷伯菌;耐碳青霉烯類(lèi);危險(xiǎn)因素;防治
[中圖分類(lèi)號(hào)] R563.1 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-9701(2018)08-0161-04
Research progress of relevant risk factors of carbapenems-resistant klebsiella pneumoniae and its prevention and treatment
HONG Jiali1 WU Junhua2 QIU Haiyan2
1.The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310051, China; 2.Pediatric Intensive Care Unit, Ningbo Women and Children’s Hospital, Ningbo 315012, China; 3.Department of Pediatric Vasculocardiology, Ningbo Women and Children’s Hospital, Ningbo 315012, China
[Abstract] The ueasonable use of carbapenems has led to an explosion in the number of resistant strains of carbapenems. Among carbapenems-resistant strains, carbapenems-resistant Klebsiella pneumoniae accounts for a significant proportion. Carbapenems-resistant Klebsiella pneumoniae has been reported in many countries around the world since it was first reported in 1997. Outbreaks have appeared in some areas even. Compared with the previous years, the data of bacterial resistance surveillance showed that the detection rate of carbapenems-resistant Klebsiella pneumoniae in China was on an upward trend. Carbapenems-resistant Klebsiella pneumoniae has a higher lethality than carbapenems-sensitive Klebsiella pneumoniae. In this paper, the progress of studies on the current status of epidemiology, related risk factors, prevention and treatment measures of carbapenems-resistant Klebsiella pneumoniae are reviewed.
[Key words] Klebsiella pneumoniae; Carbapenems-resistant; Risk factors; Prevention and treatment
肺炎克雷伯菌(Klebsiella pneumoniae,KP)臨床檢出排名僅次于大腸埃希菌的革蘭陰性菌,是重要的條件致病菌之一。機(jī)體免疫力低下時(shí),造成呼吸道、泌尿道、皮膚組織等多部位感染[1]。碳青霉烯類(lèi)抗生素屬于非典型β-內(nèi)酰胺類(lèi)抗生素,具有對(duì)β-內(nèi)酰胺酶高度穩(wěn)定及廣譜抗菌活性特點(diǎn),是革蘭陰性桿菌嚴(yán)重感染的臨床一線(xiàn)藥物。但是,由于抗生素的不合理的選擇及使用,碳青霉烯類(lèi)耐藥菌株數(shù)量激增。繼1997年首例耐碳青霉烯類(lèi)肺炎克雷伯菌(carbapenem resistant Klebsiella pneumoniae,CRKP)被報(bào)道[2]。迄今,CRKP在全球多個(gè)國(guó)家均有報(bào)道,有些國(guó)家或地區(qū)甚至出現(xiàn)了暴發(fā)流行[3-5]。與碳青霉烯類(lèi)敏感KP相比較,CRKP具有更高的致死率。本文將對(duì)CRKP的流行病學(xué)現(xiàn)狀、危險(xiǎn)因素及防治措施進(jìn)行綜述。
1 CRKP的流行病學(xué)現(xiàn)狀
1997年,有研究[2]報(bào)道了首例CRKP。目前,CRKP在世界多個(gè)國(guó)家均有報(bào)道,例如美國(guó)、英國(guó)、新加坡、中國(guó)等。2015年中國(guó)全國(guó)細(xì)菌耐藥監(jiān)測(cè)網(wǎng)數(shù)據(jù)統(tǒng)計(jì)顯示[6],2015年國(guó)內(nèi)共有21個(gè)不同地區(qū)的CRKP檢出率增加,耐藥菌株仍主要集中在華東地區(qū)。KP對(duì)碳青霉烯類(lèi)抗生素的耐藥率平均為7.6%。對(duì)比前幾年細(xì)菌耐藥監(jiān)測(cè)數(shù)據(jù),我國(guó)CRKP檢出率呈不斷上升趨勢(shì)[7]。
不同地區(qū)CRKP的定植率各有不同。Zarakolu P等[8]對(duì)土耳其某家醫(yī)院2009~2013年CRKP定植及感染情況進(jìn)行回顧性分析,結(jié)果顯示CRKP定植率為6.8%(279/4105),其中有8例CRKP定植的患者發(fā)生了CRKP血流感染。該研究中定植患者年齡中位數(shù)為56.7歲,其中165例為男性。
相關(guān)熱詞搜索:研究進(jìn)展 肺炎 克雷 防治 危險(xiǎn)
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