老年住院患者生物膜阳性KPBSI危险因素及血清CRP、PCT、SAA对预后的评估价值  

Risk factors for biofilm-positive KPBSI in elderly hospitalized patients and values of serum CRP,PCT and SAA in assessment of prognosis

作　　者：陈小敏 杨应飞 严莉 张晓霞 金美琴 汪群智[4] CHEN Xiao-min;YANG Ying-fei;YAN Li;ZHANG Xiao-xia;JIN Mei-qin;WANG Qun-zhi(Jinhua Second Hospital,Jinhua,Zhejiang 321016,China;不详)

机构地区：[1]金华市第二医院老年科,浙江金华321016 [2]金华市第二医院检验科,浙江金华321016 [3]金华市第二医院院感科,浙江金华321016 [4]金华市人民医院呼吸科,浙江金华321000

出　　处：《中华医院感染学杂志》2023年第9期1328-1332,共5页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划(2019KY746)。

摘　　要：目的探讨老年住院患者并发生物膜阳性肺炎克雷伯菌血流感染(KPBSI)危险因素及血清C-反应蛋白(CRP)、降钙素原(PCT)、淀粉样蛋白A(SAA)对预后的评估价值。方法回顾性分析2019年1月-2020年12月金华市第二医院收治的88例老年住院并发KPBSI患者,根据肺炎克雷伯菌生物膜检出情况分为阳性组57例和阴性组31例,阳性组根据3个月后存活情况分为预后良好组42例和预后不良组15例。采用Logistic回归分析老年住院患者并发生物膜阳性KPBSI的危险因素;受试者工作特征(ROC)曲线分析CRP、PCT和SAA对不良预后的诊断效能。结果Logistic回归分析结果显示,合并糖尿病、气管切开或插管、碳青霉烯类抗菌药物、抗菌药物使用时间>14 d均为老年住院患者生物膜阳性KPBSI的独立危险因素(P<0.05);预后不良组血清PCT、CRP及SAA水平均明显高于预后良好组(P<0.05);血清CRP、PCT、SAA及其联合检测预测预后不良的曲线下面积(AUC)分别为0.802、0.830、0.852和0.890(P<0.05)。结论合并糖尿病、气管切开或插管、碳青霉烯类抗菌药物、长期使用抗菌药物均为老年住院患者并发生物膜阳性KPBSI的独立危险因素,血清PCT、CRP及SAA水平可作为临床预测其不良预后的血清学检测指标。OBJECTIVE To explore the risk factors for biofilm-positive Klebsiella pneumoniae bloodstream infection(KPBSI)in elderly hospitalized patients and analyze the values of serum C-reactive protein(CRP),procalcitonin(PCT)and serum amyloid A(SAA)in assessment of prognosis.METHODS A total of 88 elderly hospitalized patients who were complicated with KPBSI and treated in Jinhua Second Hospital form Jan 2019 to Dec 2020 were retrospectively analyzed,the patients were divided into the positive group with 57 cases and the negative group with 31 cases according to the result of K.pneumoniae biofilm test.The patients of the positive group were divided into the favorable prognosis group with 42 cases and the poor prognosis group with 15 cases according to the survival status after 3 months.Logistic regression analysis was performed for the risk factors for the biofilm-positive KPBSI in the elderly hospitalized patients.The efficiencies of CRP,PCT and SAA in diagnosis of poor prognosis were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Logistic regression analysis showed that complication with diabetes mellitus,tracheotomy or endotracheal intubation,carbapenems and use of antibiotics for more than 14 days were the independent risk factors for the biofilm-positive KPBSI in the elderly hospitalized patients(P<0.05).The levels of serum PCT,CRP and SAA of the poor prognosis group were remarkably higher than those of the favorable prognosis group(P<0.05).The areas under curves(AUCs)of serum CRP,PCT,SAA and their combination were respectively 0.802,0.830,0.852 and 0.890 in prediction of poor prognosis(P<0.05).CONCLUSION The complication with diabetes mellitus,tracheotomy or endotracheal intonation,carbapenems and long-term use of antibiotics are the independent risk factors for the biofilm-positive KPBSI in the elderly hospitalized patients.Serum PCT,CRP and SAA can be used as serologic test indexes for clinical prediction of poor prognosis.

关 键 词：生物膜阳性 肺炎克雷伯菌血流感染 危险因素 C-反应蛋白 降钙素原 淀粉样蛋白A 预后 

分 类 号：R378.996[医药卫生—病原生物学]