碳青霉烯类耐药肺炎克雷伯菌血流感染的临床特征与死亡危险因素分析  

Clinical characteristics of carbapenem-resistant Klebsiella pneumoniae bloodstream infection and the risk factors of mortality

作　　者：杨修文[1] 崔俊昌[1] 赵进[1] 倪文涛[1] YANG Xiuwen;CUI Junchang;ZHAO Jin;NI Wentao(Department of Respiratory Diseases,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院呼吸内科,北京100853

出　　处：《中国感染与化疗杂志》2018年第2期142-149,共8页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金(81371855)

摘　　要：目的探讨碳青霉烯类耐药肺炎克雷伯菌(CRKP)血流感染患者的临床特征、死亡危险因素以及抗菌药物的治疗。方法回顾性分析2011年6月至2016年8月解放军总医院60例CRKP血流感染患者的临床资料,根据血流感染28 d预后将CRKP血流感染患者分为存活组(36例)和死亡组(24例),分析CRKP血流感染患者的死亡相关危险因素;同时,将其中46例接受抗菌治疗方案的CRKP血流感染患者分为联合用药组(32例)与单药组(14例),比较两组患者的差异。结果本研究共纳入60例CRKP血流感染患者,28 d病死率为40.0%(24/60)。高急性生理与慢性健康(APACHEⅡ)评分(OR=1.15,95%CI为1.0~1.3,P=0.048)为CRKP血流感染患者28 d死亡的独立危险因素。46例纳入抗菌治疗方案研究中32例接受联合用药(包括二联、三联或四联抗菌治疗方案),14例接受单药治疗,28 d总体病死率为34.8%,经单因素分析,28 d病死率在联合用药组与单药组之间的差异无统计学意义。结论 CRKP血流感染患者有着较高的病死率,APACHEⅡ评分可作为预测危重症患者预后的独立危险因子。Objective To explore the clinical characteristics,risk factors of mortality and antimicrobial therapy of carbapenemresistant Klebsiella pneumoniae(CRKP)bloodstream infections.Methods A 5-year retrospective study was conducted for 60 patients with CRKP bloodstream infection,who were treated in Chinese People’s Liberation Army(PLA)General Hospital during the period from June 2011 to August 2016.The patients were assigned to death(n=24)or survival(n=36)group according to 28-day survival after bloodstream infection to identify the predictors of mortality.The patients treated with combination antimicrobial therapy(n=32)were compared with those received monotherapy(n=14).Results A total of 60 nonduplicate CRKP blood isolates were identified.The 28-day mortality was 40.0%(24/60).High APACHEⅡscore(OR=1.15,95%CI 1.0-1.3,P=0.048)was identified as an independent risk factor for 28-day mortality in patients with CRKP bloodstream infection.The 46 patients receiving antimicrobial therapy showed 28-day mortality of 34.8%.Univariate analysis indicated that the 28-day mortality rate was similar between the patients receiving combination antimicrobial therapy and those receiving monotherapy.Conclusions Bloodstream infection due to CRKP is associated with high mortality.APACHE II score is an independent predictor for mortality in patients with CRKP bloodstream infection.

关 键 词：碳青霉烯类耐药 肺炎克雷伯菌 血流感染 死亡危险因素 

分 类 号：R978.11[医药卫生—药品]