医院获得性肺炎克雷伯菌血流感染119例临床分析  

Clinical analysis of 119 cases of hospital-acquired Klebsiella pneumoniae bloodstream infection

作　　者：陆爽爽 辛玲 沈慧[2] 杨帆[2] 袁莉莉[2] LU Shuangshuang;XIN Ling;SHEN Hui;YANG Fan;YUAN Lili(Department of Nursing,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院护理部,上海200040 [2]复旦大学附属华山医院院感科,上海200040

出　　处：《中国感染与化疗杂志》2023年第3期299-305,共7页Chinese Journal of Infection and Chemotherapy

基　　金：上海申康医院发展中心2022年度市级医院诊疗技术推广及优化管理项目(SHDC22022212)。

摘　　要：目的回顾性分析医院获得性肺炎克雷伯菌血流感染患者的临床特征、危险因素和抗菌治疗,为临床干预和治疗提供依据。方法选取2020年1月至2021年12月复旦大学附属华山医院119例医院获得性肺炎克雷伯菌血流感染患者的临床资料,根据药敏试验结果,将患者分为碳青霉烯类敏感肺炎克雷伯菌(CSKP)组和耐药(CRKP)组,比较两组的临床特点。结果基线状况显示,CRKP组入住重症监护室(ICU)多于CSKP组(42.6%对20.7%);基础疾病,CSKP组实体肿瘤高于CRKP组(36.2%对13.1%,P<0.01),而肺部感染CRKP组显著高于CSKP组(62.3%对27.6%,P<0.01)。多因素logistic回归分析显示,留置经外周静脉置入中心静脉导管、血培养前3 d内留置导尿管和使用碳青霉烯类药物是患者CRKP血流感染的独立危险因素。结论与CSKP相比,CRKP血流感染多见于ICU。根据肺炎克雷伯菌血流感染患者的临床特征及相关危险因素分析,在诊治中应尽量避免侵袭性操作,合理应用抗菌药物,从而减少CRKP血流感染的发生。Objective To retrospectively analyze the clinical characteristics,risk factors and antimicrobial therapy of patients with hospital-acquired Klebsiella pneumoniae(KP)bloodstream infection(BSI),and to provide evidence for clinical intervention and treatment.Methods The clinical data of 119 patients with hospital-acquired K.pneumoniae BSI in a tertiary teaching hospital were collected from January 2020 to December 2021.The clinical characteristics of carbapenem-sensitive K.pneumoniae(CSKP)patients and carbapenem-resistant K.pneumoniae(CRKP)patients were compared and analyzed in terms of antimicrobial susceptibility tests.Results At baseline,significantly higher proportion of patients in CRKP group(42.6%)were admitted to ICU compared to CSKP group(20.7%).The prevalence of underlying solid tumor was higher in CSKP group than that in CRKP group(36.2%vs 13.1%,P<0.01).CRKP was associated with significantly higher incidence of pulmonary infection compared to CSKP group(62.3%vs 27.6%,P<0.01).Multivariate logistic regression analysis showed that indwelling peripherally inserted central catheter(PICC),indwelling catheter within three days before blood culture,and carbapenems use were independent risk factors for CRKP BSI.Conclusions Compared with CSKP,CRKP BSI is more common in ICU.According to the clinical characteristics and relevant risk factors of KP BSI,invasive procedures should be avoided in clinical practice as far as possible and antibiotics should be used rationally for the purpose to reduce the incidence of CRKP bloodstream infection.

关 键 词：血流感染 肺炎克雷伯菌 危险因素 抗菌治疗 

分 类 号：R515.3[医药卫生—内科学]