Article(id=1261728806553903928, tenantId=1146029695717560320, journalId=1146119944283992078, issueId=1261728796072358112, articleNumber=null, orderNo=null, doi=null, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1778749189270, onlineDateStr=2026-05-14, pubDate=1774195200000, pubDateStr=2026-03-23, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1778749189270, onlineIssueDateStr=2026-05-14, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1778749189270, creator=13701087609, updateTime=1778749189270, updator=13701087609, issue=Issue{id=1261728796072358112, tenantId=1146029695717560320, journalId=1146119944283992078, year='2026', volume='4', issue='6', pageStart='1', pageEnd='234', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1778749186771, creator=13701087609, updateTime=1778750183088, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1261732975067148479, tenantId=1146029695717560320, journalId=1146119944283992078, issueId=1261728796072358112, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1261732975071342784, tenantId=1146029695717560320, journalId=1146119944283992078, issueId=1261728796072358112, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=50, endPage=54, ext={CN=ArticleExt(id=1261728808084824895, articleId=1261728806553903928, tenantId=1146029695717560320, journalId=1146119944283992078, language=CN, title=耐碳青霉烯肺炎克雷伯菌的危险因素及联合用药对替加环素异质性耐药菌株的影响研究, columnId=1151957373175820401, journalTitle=实验室检测, columnName=创新应用, runingTitle=null, highlight=null, articleAbstract=
目的 探讨耐碳青霉烯肺炎克雷伯菌（carbapenem-resistant Klebsiella pneumonia, CRKP）感染的危险因素，并分析联合用药对替加环素异质性耐药菌株体外抑菌效果的影响。
方法 采用回顾性病例对照研究方法，选取2024年3月—2025年12月本院收治的350例CRKP感染患者为CRKP组，并按照1：1比例选取同期350例碳青霉烯类敏感肺炎克雷伯菌（carbapenem-susceptible Klebsiella pneumonia, CSKP）感染患者为CSKP组。比较两组的临床资料及送检标本分布情况，采用单因素分析和多因素Logistic回归分析CRKP感染的危险因素。另选取57株CRKP临床分离菌株，采用肉汤微量稀释法测定替加环素（tigecycline, TGC）和多黏菌素B （polymyxin B, PMB）的最低抑菌浓度（minimum inhibitory concentration, MIC），应用群体分析谱（population analysis profiles, PAPs）筛选替加环素异质性耐药菌株，并利用棋盘法评价TGC联合PMB对替加环素异质性耐药菌株的联合抑菌效应。
结果 2组均以痰液为主，CRKP组痰液标本占46.86%，CSKP组占60.29%，其余标本主要为尿液、血液、引流液等其他标本。CRKP组在年龄>60岁、住院时间>14 d、心脑血管疾病、呼吸系统疾病、糖尿病、中心静脉插管、机械通气、留置尿管以及联合使用抗菌药物大于3种和使用碳青霉烯类药物方面的比例均高于CSKP组（P<0.05）。多因素Logistic分析证实呼吸系统疾病、糖尿病、机械通气、留置尿管、联合使用抗菌药物大于3种及碳青霉烯类药物使用为CRKP感染的独立危险因素（P<0.05）。TGC与PMB的MIC主要分布于0.125~0.250 μg/mL区间，随MIC水平升高菌株数逐渐减少，MIC>4 μg/mL的菌株均未检出。纸片扩散法未检出替加环素异质性耐药菌株，而PAPs法共检出24株替加环素异质性耐药菌株，检出率为42.11%。替加环素异质性耐药CRKP菌株在单用条件下的TGC MIC50/MIC90分别为2 μg/mL、4 μg/mL，PMB单用时为1 μg/mL、2 μg/mL，而TGC与PMB联合用药时MIC50/MIC90分别为1 μg/mL、2 μg/mL。在24株替加环素异质性耐药CRKP中，TGC联合PMB的抗菌效应以协同作用和相加作用为主要类型，二者比例相当，均为41.67%，无关作用占16.67%，未观察到拮抗作用。
结论 CRKP感染的发生与多种基础疾病、侵入性操作及抗菌药物使用密切相关。体外研究结果表明，TGC联合PMB可增强对替加环素异质性耐药CRKP的抑菌活性，具有一定的协同或相加效应，为CRKP感染的临床合理用药提供参考依据。
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