CRPA感染死亡患者危险因素分析及NLR值对预后的评估  

Risk Factors Analysis for Death From CRPA Infection and Evaluation of NLR Value on Prognosis

作　　者：李强 薛东杰 董珍珍 肖志忠 LI Qiang;XUE Dongjie;DONG Zhenzhen;XIAO Zhizhong(Laboratory Department,Beijing Huairou Hospital,Beijing 101400;Microbiology Department,Huairou District Center for Disease Control and Prevention,Beijing 101400)

机构地区：[1]北京怀柔医院检验科,北京101400 [2]北京市怀柔区疾病预防控制中心微生物科,北京101400

出　　处：《智慧健康》2024年第17期17-20,共4页Smart Healthcare

基　　金：北京怀柔医院院级课题《头孢他啶/阿维巴坦在碳青霉烯类耐药的肠杆菌科和铜绿假单胞菌体外抗菌活性及耐药性分析》(项目编号:HRYY-2023-03)。

摘　　要：目的分析碳青霉烯类耐药铜绿假单胞菌(CRPA)感染患者的临床特征及预后危险因素。方法收集2018年1月—2023年5月本院收治的131例确定为CRPA感染患者的临床资料和实验室数据,根据首次从患者体内分离出CRPA后的30d内的生存状态,最终将患者分为死亡组(38例)和幸存组(93例)。对患者的危险因素进行分析,对NLR值发热预后进行评估。结果死亡组CRPA感染科室分布以ICU为主,幸存组CRPA感染科室分布以呼吸科、神经外科、ICU为主,呼吸科、神经外科、ICU分布情况,差异有统计学意义(P<0.05);在死亡组中,菌株对哌拉西林/他唑巴坦、头孢他啶以及头孢吡肟的耐药率呈现出较高水平;而在幸存组中,对环丙沙星、左氧氟沙星以及哌拉西林/他唑巴坦的耐药率相对较高。特别值得注意的是,哌拉西林/他唑巴坦以及头孢吡肟在两组之间的耐药率差异,经统计分析后显示差异有统计学意义(P<0.05);入住ICU、合并曲霉菌感染及CRPA血流感染是CRPA感染死亡的独立危险因素(P<0.05)。结论我院CRPA感染住院患者发生血流感染、合并曲霉菌感染以及入住ICU是高死亡率的独立危险因素,NLR值对预测CRPA感染患者预后有一定的临床应用价值。Objective To analyze clinical characteristics and prognostic risk factors of carbapenem resistant Pseudomonas aeruginosa(CRPA)infection patients.Methods The paper analyzed 131 hospitalized patients diagnosed with CRPA infection in Beijing Huairou Hospital from January 2018 to May 2023,and evaluated prognosis of fever with NLR values.Results Distribution of CRPA infection departments in death group was ICU mainly,while in survival group,distribution of CRPA infection departments was mainly respiratory department,neurosurgery,and ICU.Distribution of respiratory department,neurosurgery,and ICU showed statistical significance(P<0.05).Strains in death group had high resistance rate to piperacillin/tazobactam,ceftazidime,and cefepime,those in survival group had higher resistance rate to ciprofloxacin,levofloxacin,piperacillin/tazobactam,while piperacillin/tazobactam and cefepime showed statistical significance(P<0.05).Admission to ICU,concomitant Aspergillus infection,and CRPA bloodstream infection was independent risk factors for CRPA infection mortality(P<0.05).Conclusion Bloodstream infection,concurrent Aspergillus infection,and ICU admission of hospitalized patients with CRPA infection in our hospital is independent risk factors for high mortality.NLR value has some certain clinical application value in predicting prognosis of CRPA infection patients.

关 键 词：碳青霉烯类耐药铜绿假单胞菌 中性粒细胞与淋巴细胞比值 受试者工作特征曲线 危险因素 

分 类 号：R446.5[医药卫生—诊断学]