肺炎克雷伯菌血流感染临床特点及死亡危险因素分析  

Clinical characteristics of Klebsiella pneumoniae-induced bloodstream infection and its analysis of risk factors for death

作　　者：任静 黄芬[2] 徐静[3] REN Jing;HUANG Fen;XU Jing(Infectious Diseases Ward of the Infection Hospital,Anhui Provincal Hospital The First Affiliated Hospital of USTC,Hefei 230000,China;Department of Epidemiology and Biostatistics,School of Public Health,Anhui Medical University,Hefei 230032,China;Department of Infectious Disease,The First Affiliated Hospital of USTC,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院·安徽省立医院感染病院感染性疾病病区,安徽合肥230000 [2]安徽医科大学流行病与卫生统计学系,安徽合肥230032 [3]中国科学技术大学附属第一医院·安徽省立医院感染病科,安徽合肥230001

出　　处：《西部医学》2023年第1期87-91,96,共6页Medical Journal of West China

基　　金：安徽省高校学科(专业)拔尖人才学术资助项目(gxbjZD09)。

摘　　要：目的分析肺炎克雷伯菌导致的血流感染的临床特点及CRKP血流感染的死亡危险因素。方法收集2020年7月~2021年12月的136例KPBSI住院患者的病例资料,分为CSKP组和CRKP组,并比较两组在科室分布、基础疾病、合并感染部位、易感因素等方面的异同。再根据血流感染90 d后的预后将CRKP组分为存活组和死亡组2个亚组,并分析CRKP的死亡危险因素。结果在入住ICU、合并肺部感染、腹腔感染、重症心脑血管疾病、危重症烧伤及创伤、插管(胃管、尿管、深静脉置管、胸腹腔穿刺)、气管插管/气管切开、外科手术等方面的患者比例,CRKP组均显著高于CSKP组(P<0.05)。反之,在合并肝胆道感染、血液/实体恶性肿瘤、化疗、介入手术(胆道支架植入、脓肿穿刺引流等)等方面的患者比例,CSKP组均显著高于CRKP组(P<0.05)。多因素关联分析的结果提示合并多脏器功能障碍综合征(OR=46.409,95%CI:4.061~530.340,P=0.002)是导致CRKP患者死亡的独立危险因素。结论CRKP多分布于ICU,肺部及腹腔感染为其常见的合并感染部位;合并重症心脑血管疾病、危重症烧伤、创伤的患者容易出现CRKP的感染;各类插管、气管插管/气管切开是CRKP产生的医源性因素;合并多脏器功能障碍综合症为CRKP的独立死亡危险因素。Objective To analyze the clinical characteristics of bloodstream infections caused by Klebsiella pneumoniae and the risk factors for mortality in CRKP bloodstream infections.Methods Data of 136 hospitalized KPBSI patients from July 2020 to December 2021 were collected.The patients were divided into CSKP group and CRKP group,and the differences and similarities between the two groups were compared in department distribution,basic diseases,co-infected sites,susceptibility factors and other aspects.Then the CRKP group was divided into two subgroups,survival group and death group,according to the prognosis after 90 days of bloodstream infection,and the risk factors of death of CRKP were analyzed.Results In terms of hospitalization in ICU,combined pulmonary infection,abdominal infection,severe cardiovascular and cerebrovascular disease,critical burns andtrauma,intubation(gastric tube,urinary catheter,deep vein placement,thoracoabdominal puncture),tracheal intubation/tracheotomy,and surgical procedures,the proportion of patients in the CRKP group was significantly higher than that in the CSKP group(P<0.05).Conversely,the proportion of patients with combined hepatobiliary tract infection,hematologic/solid malignancies,chemotherapy,and interventional procedures(biliary stenting,abscess puncture and drainage,etc.)was significantly higher in the CSKP group than in the CRKP group(P<0.05).The results of multifactorial association analysis suggested that combined multiple organ dysfunction syndrome(OR=46.41,95%CI:4.061~530.340,P=0.002)was an independent risk factor for death in patients with CRKP.Conclusion CRKP is mostly distributed in ICU.Lung and abdominal infection are the common co-infection sites.Patients with severe cardiovascular and cerebrovascular disease,critical burns andtrauma are prone to CRKP infection.All kinds of intubation,endotracheal intubation/tracheotomy are iatrogenic factors of CRKP.Multiple organ dysfunction syndrome was an independent risk factor for death in CRKP.

关 键 词：血流感染 肺炎克雷伯菌 耐碳青霉烯类 临床特点 危险因素 

分 类 号：R563[医药卫生—呼吸系统]