摘要
目的了解肺炎克雷伯菌血流感染(Kp BSI)患者的临床特征、耐药情况及预后相关因素。方法回顾性分析首都医科大学附属北京世纪坛医院2017年1月1日至2021年12月1日收治的188例Kp BSI患者临床资料。其中男性118例(62.8%);年龄77.0(63.0,85.0)岁,住院时间20.0(9.0,33.8)d,入住重症监护病房(ICU)者78例(41.5%);碳青霉烯类敏感肺炎克雷伯菌(CSKP)感染者121例(占64.4%,CSKP组),碳青霉烯类耐药肺炎克雷伯菌(CRKP)感染者67例(占35.6%,CRKP组);入院28 d内死亡56例(死亡组),生存132例(生存组)。采用单因素分析及多因素logistic回归分析CRKP血流感染及预后相关因素。结果188例Kp BSI患者感染部位较多者依次为呼吸系统39.4%(74/188)、腹腔感染18.1%(34/188)、胆道感染14.4%(27/188)。所患基础疾病依次为冠心病63.8%(120/188)、高血压59.6%(112/188)、慢性肾脏疾病46.3%(87/188)、2型糖尿病43.1%(81/188);118例(62.8%)患≥3种基础疾病。Kp BSI前有侵入性操作史者146例(77.7%),有抗生素使用史者90例(47.9%)。CRKP对哌拉西林、喹诺酮类、头孢菌素、碳青霉烯类药物均有较高的耐药性。单因素分析显示,CSKP组与CRKP组的年龄(69.0比83.0岁)、入住ICU[25.6%(31/121)比70.1%(47/67)]、侵入性操作史[67.8%(82/121)比95.5%(64/67)]、抗生素使用史[37.2%(45/121)比67.2%(45/67)]比较,差异均有统计学意义(Z=-5.73,χ^(2)=35.22,χ^(2)=19.15,χ^(2)=15.53,均P<0.001)。多因素logistic回归分析,年龄、入住ICU、侵入性操作史、抗生素使用史是CRKP感染的影响因素(OR=1.06,P<0.001;OR=3.22,P=0.003;OR=5.93,P=0.009;OR=2.40,P=0.022)。入院28 d内总病死率为29.8%(56/188),单因素分析显示,生存组与死亡组的CRKP感染[19.7%(26/132)比73.2%(41/56)]、白蛋白水平(32.6比27.8 g/L)、序贯性器官衰竭评分(SOFA评分,2比8分)比较,差异均有统计学意义(χ^(2)=49.10,Z=-4.64,Z=-10.36,均P<0.001)。多因素logistic回归分析提示,CRKP感染、低白蛋白、高SOFA评�
Objective To analyze the clinical characteristics,antibiotic resistance and prognostic risk factors of patients with Klebsiella pneumoniae bloodstream infection(Kp BSI).Methods The clinical data of 188 patients diagnosed with Kp BSI from January 1,2017 to December 1,2021 in Beijing Shijitan Hospital,Capital Medical University were retrospectively analyzed.There were 118 patients males(62.8%)with a median age 77.0(63.0,85.0)years old.The median length of hospital stay was 20.0 days,and 78 patients(41.5%)were admitted to intensive care unit(ICU).There were 121 cases with carbapenem-sensitive Klebsiella pneumoniae(64.4%,CSKP group)and 67 cases with carbapenem-resistant Klebsiella pneumoniae(35.6%,CRKP group).Fifty six patients died within 28 days after admission(death group),and 132 patients survived(survival group).The clinical characteristics and bacterial drug resistance of Kp BSI patients were analyzed,and univariate analysis and multivariate logistic regression analysis were used to explore factors related to the CRKP infection and patient mortality.Results The most common infection sites were respiratory system,abdominal cavity and biliary tract accounting for 39.4%(74/188),18.1%(34/188)and 14.4%(27/188),respectively.The common comorbidities were coronary heart disease,hypertension,chronic kidney disease and diabetes,accounting for 63.8%(120/188),59.6%(112/188),46.3%(87/188)and 43.1%(81/188),respectively and 118 patients(62.8%)had 3 or more comorbidities.Most patients(146 cases,77.7%)underwent≥1 invasive procedures before bloodstream infection;and 90 patients(47.9%)had a history of antibiotic use.CRKP strains showed higher resistance rates to piperacillin,quinolones,cephalosporins and carbapenems.Univariate analysis showed that there were statistically significant differences in age(69.0 vs.83.0 years),ICU admission 25.6%(31/121)vs.70.1%(47/67)],invasive procedures[67.8%(82/121)vs.95.5%(64/67)],and antibiotic use[37.2%(45/121)vs.67.2%(45/67)]between the CSKP group and the CRKP group(Z=-5.73,χ^(2)=35.22,χ^(
作者
李秋敬
王真
高倩
张玥
王薇
Li Qiujing;Wang Zhen;Gao Qian;Zhang Yue;Wang Wei(Department of Emergency Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)
出处
《中华全科医师杂志》
2022年第6期560-566,共7页
Chinese Journal of General Practitioners
基金
首都医科大学附属北京世纪坛医院院基金(2019C07)。
关键词
克雷伯菌
肺炎
菌血症
血流感染
克雷伯菌感染
抗药性
多种
细菌
影响因素
Klebsiella pneumoniae
Bacteremia
Bloodstream infection
Klebsiella infections
Drug resistance,multiple,bacterial
Related factors
