摘要
目的探讨影响院内获得性耐碳氢酶烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae CRKP)血流感染的老年危重病患者预后的相关因素。方法回顾性分析2010年1月至2016年12月我院重症医学科(ICU)内院内获得性CRKP血流感染的老年危重病患者的临床资料,根据预后分为死亡组和生存组,比较两组患者的临床特点,采用Logistic回归筛选影响ICU内院内获得性CRKP血流感染老年危重病患者预后的相关因素。结果共纳入119例CRKP血流感染老年危重病患者,ICU内病死率为62.2%(74/119),使用替加环素治疗者病死率较未使用替加环素者病死率低[50.0%(25/50)比71.0%(49/69),χ^2=4.770,P=0.029];联合抗菌药物治疗较单药治疗病死率低[54.9%(39/71)比72.9%(35/48),χ^2=3.940,P=0.047)]。多因素Logistic回归分析结果显示,使用血管活性药物(OR=25.545,95%CI:9.743~52.242,P=0.001)、替加环素药敏为耐药(OR=8.990,95%CI:0.957~24.488,P=0.049)是死亡的独立危险因素,进行合适的初始治疗(定义为48 h内至少采用1种敏感抗生素治疗,OR=0.081,95%CI:0.014~0.463,P=0.005)及足够的合适抗生素治疗疗程(OR=0.785,95%CI:0.631~0.977,P=0.030)是改善预后的保护因素。结论ICU内获得性CRKP血流感染的老年患者病死率高,合适的初始治疗及足够的疗程能明显降低死亡风险。
Objective To investigate the related risk factors for the prognosis of hospital-acquired carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infections in elderly patients with critical illness.Methods Clinical data of elderly patients with nosocomial CRKP bloodstream infection in intensive care unit(ICU)from Jan.2010 to Dec.2016 were retrospectively analyzed.Patients were divided into the death and survival groups according to the prognosis.Clinical characteristics were compared between the two groups.Influencing factors for the prognosis of nosocomial CRKP bloodstream infections in elderly ICU patients were screened by multivariate Logistic regression analysis.Results A total of 119 elderly ICU patients with nosocomial CRKP bloodstream infection were enrolled.The overall ICU mortality rate was 62.2%(74/119 patients),among which the ICU mortality was lower in patients treated with tigecycline than without tigecycline treatment(50.0%or 25/50 vs.71.0%or 49/69,χ^2=4.770,P=0.029).And the ICU mortality was lower in patients with combination therapy than with mono-therapy(54.9%or 39/71 vs.72.9%or 35/48,χ^2=3.940,P=0.047).Multivariate Logistic regression analysis revealed that the administration of vasoactive drugs(OR=25.545,95%CI:9.743-52.242,P=0.001),and the resistance to tigecycline(OR=8.990,95%CI:0.957-24.488,P=0.049)were independent risk factors for ICU mortality.While the early initiated appropriate antibiotics treatment,which was defined as using at least one susceptible antibiotic within 48 hours(OR=0.081,95%CI:0.014-0.463,P=0.005),and appropriate antibiotics and adequate duration(OR=0.785,95%CI:0.631-0.977,P=0.030),were protective factors for the good outcome.Conclusions Nosocomial CRKP bloodstream infection in elderly ICU patients leads a high ICU mortality rate.The early initiated appropriate antibiotics treatment and optimum antibiotics duration could reduce the risk for death.
作者
杨向红
何方
吕智全
洪军
陈敏华
孙仁华
Yang Xianghong;He Fang;Lyu Zhiquan;Hong Jun;Chen Minhua;Sun Renhua(Intensive Care Unit,Zhejiang Provincial People’s Hospital,People’s Hospital of Hangzhou Medical College,Hangzhou 310014,China;Department of Clinical Laboratory,Zhejiang Provincial People’s Hospital,People’s Hospital of Hangzhou Medical College,Hangzhou 310014,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2020年第5期530-534,共5页
Chinese Journal of Geriatrics
基金
国家自然青年科学基金项目(81702042)。
关键词
肺炎
克雷伯菌感染
预后
危险因素
Pneumonia
Klebsiella infections
Prognosis
Risk factors
