肺炎克雷伯菌导尿管相关性尿路感染单中心临床特点及危险因素分析  

Single center clinical characteristics and risk factors of catheter-associated urinary tract infections caused by Klebsiella pneumoniae

作　　者：刘晓蕾[1] 黄欢[1] 朱长清[1] 杭瑛[1] LIU Xiaolei;HUANG Huan;ZHU Changqing;HANG Ying(Department of Emergency,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai,200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院急诊科,上海200127

出　　处：《临床急诊杂志》2021年第5期339-343,共5页Journal of Clinical Emergency

摘　　要：目的:探讨肺炎克雷伯菌(KP)引起的导尿管相关性尿路感染(CAUTIs)的临床特征和危险因素,为临床日常诊疗提供有意义的依据。方法:回顾性分析2012年1月—2018年1月期间在我院急诊诊治的50例KP导尿管相关性尿路感染(KP-CAUTIs)患者的临床资料。收集记录患者的人口学特征和临床结果,采用binary logistic回归模型分析危险因素。结果:50例KP-CAUTIs患者中,74%为男性,年龄多在65岁以上,医院内获得性感染多见,患者住院时间常大于1个月。KP-CAUTIs患者常伴随多种慢性合并症。侵入性操作、广谱β-内酰胺酶(ESBL)表达和多药耐药(MDR)在KP-CAUTIs患者中所占比例较高。抗生素药敏方面,KP-CAUTIs患者对大多数常见抗生素均显示不同程度的耐药性。Logistic回归分析显示,根据ESBL表达分组后,复杂尿路感染(cUTI)是ESBL阳性KP-CAUTIs的独立危险因素(OR=48.568;95%CI:4.082~577.794;P=0.002)。结论:KP-CAUTIs患者表现出较为鲜明的临床特征。cUTI是影响KP-CAUTIs患者ESBL表达的潜在危险因素。Objective: To investigate the clinical characteristics and risk factors of catheter-associated urinary tract infections(CAUTIs) caused by Klebsiella pneumoniae(KP), and to provide meaningful basis for daily clinical treatment. Methods: The clinical data of 50 cases of KP catheter-related urinary tract infection(KP-CAUTIs) in our hospital from January 2012 to January 2018 were retrospectively analyzed. Demographic characteristics and clinical results were collected and recorded. The risk factors were analyzed by using binary logistic regression model. Results: Among the 50 KP-CAUTIs patients, 74% were male, most of them were over 65 years old. Nosocomial acquired infections were common, and the length of stay was more than one month. KP-CAUTIs patients are often accompanied by a variety of chronic complications. Invasive operation, broad spectrum β-Lactamase(ESBL) expression and multidrug resistance(MDR) accounted for a high proportion in KP-CAUTIs patients. In terms of antibiotic susceptibility, KP-CAUTIs patients showed different degrees of resistance to most common antibiotics. Logistic regression analysis revealed that complicated urinary tract infection(cUTI) was an independent risk factor for ESBL positive KP-CAUTIs[OR=48.568;95%CI:4.082-577.794;P=0.002].Conclusion: KP-CAUTIs patients show distinct clinical features. Cuti is a potential risk factor for ESBL expression in KP-CAUTIs patients.

关 键 词：导尿管相关性尿路感染 肺炎克雷伯菌 广谱Β-内酰胺酶 危险因素 

分 类 号：R472[医药卫生—护理学]