شیوع ایزوله های کلبسیلا پنومونیه مقاوم به کارباپنم و اثر فاکتورهای خطر دخیل در طول مدت بستری و مرگ ومیر
محورهای موضوعی : باکتری شناسی
1 - گروه زیست فناوری میکروبی، دانشکده زیست فناوری، دانشگاه تخصصی فناوری های نوین آمل، مازندران، ایران.
کلید واژه: کلبسیلا پنومونیه مقاوم به کارباپنم, مدت بیمارستانی شدن, بخش مراقبت های ویژه, مرگ ومیر ,
چکیده مقاله :
سابقه و هدف: ظهور کلبسیلا پنومونیه مقاوم به کارباپنم (CRKP) به عنوان یک تهدید جدی از سوی سازمان بهداشت جهانی معرفی شده است. هدف از این مطالعه، بررسی شیوع عفونت های کلبسیلا پنومونیه، الگوی مقاومت آنتی بیوتیکی و فاکتورهای خطر دخیل در مرگ و میر بیمارانCRKP می باشد.
مواد و روش ها: از بیماران بستری در ICU 200 نمونه عفونی جمع‌آوری شد و پس از شناسایی ایزوله های کلبسیلا پنومونیه و بررسی الگوی مقاومت آنتی بیوتیکی شان، با استفاده از مدل سازی رگرسیون خطی و لجستیک چند متغیره، اثراحتمالی چندین فاکتور خطر در طول مدت بستری و مرگ ومیر بیماران CRKP بررسی شد.
یافته ها: 124 نمونه (62 %) دارای باکتری کلبسیلا پنومونیه بودند. مقاومت آنتی بیوتیکی به کارباپنم ها (8/54 %)، سفالوسپورین ها (72%)، فلوروکینولون ها (7/87 %)، آمینوگلیکوزیدها (87%) و کلیستین (75%) به طور معناداری در بیماران CRKP بالاتر بود. نسبت ایزوله های مقاوم به چندین دارو (MDR) و تولید کننده بتالاکتاماز وسیع الطیف (ESBL) به ترتیب 7/67 % و 29% بودند. بیماری های زمینه ای (03/ 0 P=) و CRKP (01/0P=) دو فاکتور خطر مستقل دخیل در طول مدت بستری بودند. ارتباط معناداری میان سن بالا(04/ 0 P=) و مقاومت به کارباپنم (03/ 0 P=)، با مرگ و میر نیز وجود داشت.
نتیجه گیری: با توجه به ارتباط نرخ مقاومت بالای کارباپنم با طول مدت بستری و مرگ ومیر ، لزوم نظارت بر الگوی مقاومت میکروبی، و تجویز آنتی بیوتیک های ترکیبی جدید، می تواند در تسریع روند بهبودی و کاهش طول مدت بستری موثر باشد.
Background & Objectives: The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections has been identified as a serious threat. This study aimed to investigate the prevalence of K. pneumoniae infections, antibiotic resistance patterns, and risk factors involved in increased mortality among patients with CRKP infection. Material and methods: 200 infectious samples were collected from ICU patients. After identifying Klebsiella pneumoniae isolates and examining their antibiotic resistance patterns, the effect of several possible risk factors on hospitalization duration and mortality was investigated using linear regression and a multivariate logistic regression model.
Results: One hundred and twenty-four samples (62%) contained K. pneumoniae isolates. The resistance to carbapenems (54.8%), cephalosporins (72%), fluoroquinolones (87.7%), aminoglycosides (87%), and colistin (75%) was significantly higher among CRKP patients than those susceptible to carbapenem. The proportions of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing isolates were 67.7% and 29%, respectively. Underlying diseases (P= 0.03) and resistance to carbapenem (P=0.001) were two independent risk factors associated with the duration of hospitalization. Additionally, there was a significant association between older age (P=0.04) and resistance to carbapenem (P=0.03) with mortality.
Conclusions: Given the high rate of CRKP, its association to length of hospital stays and patient mortality, and the increase in multidrug-resistant isolates, the need for monitoring of microbial resistance patterns and the prescription of new combination antibiotic regimens could be effective in improving the recovery process and reducing the duration of hospital stays of patients.
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