碳青霉烯耐药肠杆菌科细菌感染患者临床结局影响因素分析  

Relative risk factor analysis with mortality of patients with carbapenem-resistant Enterobacteriaceae infection

作　　者：李湘燕[1] 黄磊[2] 崔洪[1] LI Xiang-yan;HUANG Lei;CUI Hong(Department of Anti-infection, Institute of Clinical Pharmacology,Peking University First Hospital,Beijing 100034,China;Department of Clinical Laboratory,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院抗感染科,临床药理研究所,北京100034 [2]北京大学第一医院检验科,北京100034

出　　处：《中国临床药理学杂志》2019年第14期1442-1445,共4页The Chinese Journal of Clinical Pharmacology

摘　　要：目的通过回顾分离出碳青霉烯耐药肠杆菌科细菌(CRE)病例的临床和微生物学特征及临床医师在实践中的治疗决策,分析真实病例中CRE患者临床结局的影响因素。方法我院2011年至2017年第1次分离出CRE的患者250例,通过电子病历系统收集患者资料,用Logitistic回归分析患者死亡的独立影响因素。结果有143例患者被临床医师判定为CRE感染,判定为感染菌株的病例30 d全因死亡率显著高于判定为定植者(P <0. 05)。感染组患者中30 d死亡的病例年龄更大(P <0. 01),Charlson合并症指数、脓毒症相关器官功能衰竭评分(SOFA)值更高(P <0. 01;P <0. 01),接受抗菌药物联合治疗的比例更高(P <0. 05)。30 d全因死亡的多因素分析发现:Charlson合并症指数升高、SOFA值升高为30 d全因死亡的独立危险因素。结论患者基础疾病以及病情严重程度是CRE感染患者死亡的独立影响因素。Objective To analyze the relative risk factors of mortality of patients with carbapenem - resistant Enterobacteriaceae ( CRE) infection by retrospectively summarizing the clinical and microbiological characteristics of CRE cases and the treatment option of clinicians in practice. Methods A total of 250 patients with CRE which were isolated from 2011 to 2017 in Peking University First Hospital were included. Patients data were collected through the electronic medical record system. Logistic regression analysis was performed to identify risk factors of mortality with CRE patients. Results A total of 143 patients were identified as CRE infection by the clinician,and the 30 d all - cause mortality rate of the infected group was significantly higher than colonization group ( P < 0. 05). The 30 d deaths in the infected group were present as older age ( P < 0. 01),the higher Charlson comorbidity index ( P < 0. 01) and the higher sepsis - related organ failure score ( SOFA)( P < 0. 01). The proportion of accepting combination antibiotic therapy was higher in death cases ( P < 0. 05). Multivariate analysis of 30 d all - cause mortality found that the higher Charlson comorbidity index and the higher SOFA value were independent risk factors of 30 d all - cause death. Conclusion The underlying disease and severity of the disease are independent factors related to the death of patients with CRE infection.

关 键 词：碳青霉烯耐药肠杆菌科细菌 死亡率 抗菌药物 

分 类 号：R97[医药卫生—药品]