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目的 探讨急诊手术术后入住外科重症监护病房感染耐碳青霉烯类肺炎克雷伯菌(CRKP)的流行病学特点及易感因素.方法 回顾性分析2014年1月—2016年12月急诊术后入住苏州大学附属第一医院ICU体液标本分离出肺炎克雷伯菌(KP)的患者资料,分析产生耐药性的危险因素.结果 (1)分离出的133 株KP中,CRKP占16 株,CRKP对复方磺胺、庆大霉素、丁胺卡那、环丙沙星敏感,其耐药率分别为56.25%、87.50%、81.25%、93.75%.(2)单因素分析得出首次分离出KP的时间＞2 周、机械通气＞2 周、留置胃管、纤支镜检查、深静脉穿刺、连续性肾脏替代治疗(CRRT)、多脏器功能不全(MODS)(≥3)、真菌感染、感染1 周前使用碳青霉烯类抗菌药、降钙素原(PCT)＞2 μg/L是ICU中感染CRKP的危险因素(P＜0.05).Logistic回归分析发现首次分离出KP的时间＞2周、机械通气＞2周、纤支镜检查、CRRT、MODS (≥3)、真菌感染、感染1 周前使用碳青霉烯类抗菌药、PCT＞2 μg/L是ICU中感染CRKP的独立危险因素.结论 KP的耐药性逐年增加,缩短住院时间、减少有创操作、合理使用抗生素可减少耐药菌感染的发生.“,”Objective To investigate the epidemiological characteristics and susceptible factors of ICU infection with carbapenem resistance Klebsiella pneumonia (CRKP) after operation in emergency surgery in order to prevent and control CRKP infection. Methods A retrospective analysis of clinical data of patients with Klebsiella pneumoniae (KP) isolated from ICU body fluid samples of the First Affiliated Hospital of Soochow University from January 2014 to December 2016 after emergency surgery was conducted to analyze the risk factors for drug resistance. Results (1)Among the 133 isolates of KP, CRKP accounted for 16 cases, CRKP were sensitive to compound sulfamethoxazole, gentamicin, amikacin and ciprofloxacin, and the sensitivity was 56.25%, 87.50%, 81.25% and 93.75%. (2)Univariate analysis revealed the time of isolation of KP ＞ two weeks, mechanical ventilation ＞ two weeks, use of gastric tube, fiberoptic bronchoscopy, deep vein puncture, CRRT, MODS (≥3), fungal infection, use of carbapenem antibiotic within one week of infection, procalcitonin ＞ 2 μg/L were risk factors for CRKP infection in ICU. Logistic regression analysis revealed that the time of isolation of KP ＞ two weeks, mechanical ventilation ＞ two weeks, fiberoptic bronchoscopy, CRRT, MODS (≥3), fungal infection, use of carbapenem antibiotic within one week of infection, procalcitonin ＞ 2 μg/L were independent risk factors for CRKP infection in ICU. Conclusion Drug resistance of KP increased year by year, thus, shortening the time of hospitalization, reducing the invasive operation, reasonable use of antibiotics can reduce the occurrence of drug-resistant bacteria infection.