肺炎克雷伯菌继发性血流感染患者的临床特征和危险因素分析  

Analysis of clinical features and risk factors of secondary bloodstream infection with Klebsiella pneumoniae

作　　者：詹圆[1] 赵晶晶[1] 张骏飞 姚莉[1] ZHAN Yuan;ZHAO Jingjing;ZAHNG Junfei;YAO Li(Department of Intensive Care Unit,the Second People′s Hospital of Hefei/Hefei Hospital Affiliated to Anhui Medical University,Hefei,Anhui 230011,China;the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]合肥市第二人民医院/安徽医科大学附属合肥医院重症医学科,安徽合肥230011 [2]安徽医科大学第一附属医院,安徽合肥230022

出　　处：《临床肺科杂志》2024年第8期1140-1145,共6页Journal of Clinical Pulmonary Medicine

基　　金：安徽省重点研究与开发计划(No.2022e07020078)。

摘　　要：目的 分析肺炎克雷伯菌感染的临床资料,探讨继发血流感染的危险因素。方法 收集安徽医科大学附属合肥医院重症监护病房2020年1月至2023年12月128例肺炎克雷伯菌肺炎患者的临床资料及实验室数据,根据患者的临床资料分为肺炎克雷伯菌继发血流感染组和肺炎克雷伯菌非血流感染组,回顾性分析两组患者临床资料的差异性,将P<0.05的指标进行多因素分析,采用ROC曲线分析肺炎克雷伯菌血流感染的危险因素。结果 肺炎克雷伯菌继发血流感染组中的患者年龄、合并高血压病、COPD及有创操作(机械通气)的比例均显著高于非血流感染组,差异均具有统计学意义(P<0.05);血流感染组感染严重指数APACHEⅡ评分、SOFA评分分别为23.0(16.0, 26.5)分和5.0(3.0, 8.0)分,脓毒性休克发生率以及28天死亡率分别为85.2%和41.0%,非血流感染组分别为12.0(9.0, 20.0)分、4.0(2.0, 5.0)分、65.7%和23.9%,两组差异均有统计学意义(P<0.05)。血流感染组的C-反应蛋白水平及APTT指数、血小板指数高于非血流感染组,两组差异明显(P<0.05)。多因素分析结果表明,年龄(OR=1.045,95%CI=1.000~1.092,P=0.048)、机械通气(OR=3.404,95%CI=1.205~9.615,P=0.021)、APACHEⅡ评分(OR=1.058,95%CI=1.001~1.127,P=0.047)、C-反应蛋白水平(OR=1.007,95%CI=1.001~1.014,P=0.032)是肺炎克雷伯菌继发血流感染的独立危险因素。结论 高龄、机械通气、高APACHEⅡ评分以及C-反应蛋白水平高的肺炎克雷伯菌感染患者继发血流感染的风险高。Objective To analyze the clinical data of Klebsiella pneumoniae infection,and to explore the risk factors of secondary bloodstream infection.Methods The clinical data and laboratory data of 128 patients with Klebsiella pneumoniae pneumonia in the intensive care Unit of Hefei Hospital Affiliated to Anhui Medical University from January 2020 to December 2023 were collected.According to the clinical data,the patients were divided into the secondary bloodstream infection group of Klebsiella pneumoniae and the non-bloodstream infection group.The differences in clinical data between the two groups were analyzed by regression.The risk factors of Klebsiella pneumoniae bloodstream infection were analyzed by ROC curve with P<0.05.Results The age and the proportion of patients with hypertension,COPD and invasive operation(mechanical ventilation)in the secondary bloodstream infection group were significantly higher than those in the non-bloodstream infection group(P<0.05).In the blood flow infection group,the scores of APACHEⅡand SOFA were 23.0(16.0,26.5)and 5.0(3.0,8.0),respectively.The incidence of septic shock and 28-day mortality were 85.2%and 41.0%,respectively.In the non-bloodstream infection group,the numbers were 12.0(9.0,20.0),4.0(2.0,5.0),65.7%and 23.9%,respectively,and the difference between the two groups was statistically significant(P<0.05).The levels of C-reactive protein,APTT index and platelet index in the bloodstream infection group were higher than those in the non-bloodstream infection group,and the differences between the two groups were obvious(P<0.05).The results of multivariate analysis showed that age(OR=1.045,95%CI=1.000~1.092,P=0.048),mechanical ventilation(OR=3.404,95%CI=1.205~9.615,P=0.021),APACHE II score(OR=1.058,95%CI=1.001~1.127,P=0.047)and C-reactive protein level(OR=1.007,95%CI=1.001~1.014,P=0.032)were independent risk factors for secondary bloodstream infection of Klebsiella pneumoniae.Conclusion Elderly patients with Klebsiella pneumoniae infection,mechanical ventilation,high APACHE II

关 键 词：肺炎克雷伯菌 继发血流感染 临床分析 危险因素 

分 类 号：R516[医药卫生—内科学]