耐碳青霉烯类肺炎克雷伯菌血流感染危险因素及预后分析  

Risk factors and prognosis of carbapenem-resistant Klebsiella pneumoniae bloodstream infection

作　　者：禄梦笛 蔡依含 凌勇 张莉滟 赵越 LU Meng-di;CAI Yi-han;LING Yon;ZHANG Li-yan;ZHAO Yue(Department of Clinical Laboratory,Guangdong Provincia People's Hospital/Guangdong Academy of Medical Sciences,Southern Medical University,Guangzhou 510080,Guangdong,China;不详)

机构地区：[1]南方医科大学附属广东省人民医院/广东省医学科学院检验科,广东广州510080 [2]南方医科大学附属小榄医院检验科,广东中山528415

出　　处：《广东医学》2024年第8期981-987,共7页Guangdong Medical Journal

基　　金：广东省基础与应用基础研究基金项目(2021A1515220022)。

摘　　要：目的探讨患者院内碳青霉烯耐药肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)血流感染的危险因素及临床预后,为CRKP血流感染治疗提供科学的理论依据。方法采用病例-对照1:2研究方法,回顾性分析广东省人民医院2012年1月至2022年12月临床诊断为CRKP血流感染的患者病例资料,按患者标本血培养28d预后情况将CRKP组分为生存组与死亡组,应用单因素及多因素logistics回归分析CRKP血流感染相关危险因素和影响CRKP血流感染28d预后的重要危险因素,并应用Kalan-Meier绘制生存曲线分析其生存情况。结果中心静脉插管(P=0.042)、伴有其他部位感染(P=0.028)与既往抗菌药物使用(P<0.001)可能是导致院内CRKP血流感染发生的重要危险因素。心脑血管疾病(P=0.029)是致CRKP血流感染患者28d死亡的主要危险因素,且CRKP组患者的病死率明显高于碳青霉烯类敏感肺炎克雷伯菌(carbapenem-sensitive Klebsiella pneumoniae,CSKP)组(P<0.001)。结论CRKP血流感染病死率较高,严重影响患者预后。临床应加强对此类患者的防护,减少CRKP血流感染的发生,遏制CRKP在院内流行传播。Objective To explore the risk factors and clinical prognosis of patients with carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection in hospital,and provide a scientific basis for the effective control of CRKP bloodstream infection.Methods Adopting a case-control study in a 1:2 ratio,cases of CRKP bloodstream infection in Guangdong Provincial People's Hospital from January 2012 to December 2022 were collected and analyzed through retrospective analysis.Based on the results of the blood culture for 28 days,the CRKP group was divided into a survival group and a death group.Meanwhile,univariate and multivariate logistics regression were applied to analyze the related risk factors of CRKP bloodstream infection and the important risk factors affecting the prognosis of CRKP bloodstream infection in 28 days.Kalan-Meier was employed to plot the survival curve.Results Central venous intubation(P=0.042),other site infections(P=0.028),and previous use of antibiotics(P<0.001)may be important risk factors for CRKP bloodstream infection in the hospital.Cardiovascular and cerebrovascular diseases(P=0.029)were the main risk factors for patients infected with CRKP dead in 28 days,and the death rate of patients in the CRKP group was significantly higher than that in the carbapenem-sensitive Klebsiella pneumoniae(CSKP)group(P<0.001).Conclusion The high fatality rate of CRKP bloodstream infection seriously affects the prognosis of patients.Hence,the clinic should endeavor to protect patients from infection,reduce the occurrence of CRKP bloodstream infection,and curb the spread of CRKP in hospital.

关 键 词：耐碳青霉烯肺炎克雷伯菌 血流感染 危险因素 临床预后 

分 类 号：R378[医药卫生—病原生物学] R446.5[医药卫生—基础医学]