耐碳青霉烯类肺炎克雷伯菌感染与定植患者预后相关因素分析  

Related risk factors for prognosis of patients with carbapenem-resistant Klebsiella pneumoniae infection or colonization

作　　者：叶相如 胡必杰[1,2] 周春妹[3] 周昭彦[3] 黄声雷[3] 单玉璋 朱晨迪 高晓东[2] 

机构地区：[1]复旦大学附属中山医院呼吸内科,上海200032 [2]复旦大学附属中山医院医院感染管理科,上海200032 [3]复旦大学附属中山医院临床微生物实验室,上海200032

出　　处：《中华医院感染学杂志》2015年第11期2489-2491,共3页Chinese Journal of Nosocomiology

基　　金：国家科技重大专项基金资助项目(2013ZX10004217005)

摘　　要：目的了解耐碳青霉烯类肺炎克雷伯菌(CRKP)感染/定植患者的临床特征及预后相关危险因素。方法收集2012-2014年医院CRKP感染/定植患者71例,利用医院病历系统整理统计患者临床资料,预后相关危险因素采用logistic回归分析。结果 CRKP感染/定植患者送检标本主要为痰液占57.7%,其次为尿液、引流液等;2012-2014年住院患者检出KPN共860株,其中检出CRKP 90株,检出率10.5%;71例CRKP感染/定植患者死亡25例,病死率为35.2%;非条件logistic回归模型后显示,年龄、糖肽类抗菌药物治疗、患有糖尿病及血清白蛋白≤30g/L是其死亡的独立危险因素。结论 CRKP感染/定植常发生于老年患者,既往多有抗菌药物应用史,尤其碳青霉烯类药物,老龄、低白蛋白血症、糖尿病及糖肽类类应用是引起其死亡的独立危险因素。OBJECTIVE To understand the clinical characteristics of the patients with carbapenem‐resistant K leb‐siella pneumoniae （CRKP ） infection or colonization and determine risk factors associated with prognosis . METHODS A total of 71 patients with CRKP infection or colonization who were treated in the hospital from 2012 to 2014 were enrolled in the study ,then the clinical data of the participants were collected and cleared up by using the hospital medical records system ,and the logistic regression analysis was performed for the related risk factors for the prognosis .RESULTS Of the submitted specimens obtained from the patients with CRKP infection or colonization ,57 .7% were the sputum specimens ,followed by the urine and drainage fluid specimens .Totally 860 strains of K .pneumoniae have been isolated from the patients who were hospitalized from 2012 to 2014 ,of which 90 （10 .5% ） were the CRKP .Of the 71 patients with CRKP infection or colonization ,25 cases died ,with the mortality rate of 35 .2% .The non‐conditional logistic regression analysis indicated that the age ,glycopeptides an‐tibiotics therapy ,diabetic mellitus ,and serum albumin level no more than 30 g/L were the independent risk factors for the death .CONCLUSIONS The CRKP infection or colonization tends to occur in the elderly patients who have the history of use of multiple antibiotics , especially the carbapenems . The old age , hypoalbuminemia , diabetic mellitus ,and use of glycopeptides are the independent risk factors for the death .

关 键 词：碳青霉烯类 肺炎克雷伯菌 危险因素 

分 类 号：R181.32[医药卫生—流行病学]