呼吸重症监护室多重耐药肺炎克雷伯杆菌肺炎的危险因素  

Risk factors of Multidrug-resistant Klebsiella pneumoniae in patients with pneumonia in RICU

作　　者：殷晓娜 王晓琼[1] 董琳 杜方兵 徐楚楚 王勇生 YIN Xiaona;WANG Xiaoqiong;DONG Lin;DU Fangbing;XU Chuchu;WANG Yongsheng(Department of Respiratory Medicine,The Second People's Hospital of Hefei,Hefei Hospital Affiliated of Anhui Medical University,Hefei 230011,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呼吸与危重症医学科,安徽合肥230011

出　　处：《西部医学》2024年第10期1527-1531,共5页Medical Journal of West China

基　　金：安徽省高校科研项目(2024AH050703);蚌埠医科大学科技项目(2023byzd248);合肥市卫生健康应用医学科研项目(HWK2023 zd012)。

摘　　要：目的探讨呼吸重症监护室(RICU)多重耐药肺炎克雷伯杆菌(MDR-KPN)感染患者的危险因素及预后。方法纳入2021年1月-2023年4月合肥市第二人民医院呼吸与危重症医学科RICU病房内明确诊断为肺炎的患者109例行回顾性分析,将纳入患者分为MDR-KPN组(58例)和非MDR-KPN组(51例),采用单因素分析及多因素Logistic回归模型,分析RICU患者MDR-KPN感染的独立危险因素并构建预测模型。结果MDR-KPN组患者ICU住院时间比非MDR-KPN组住院时间长(P>0.05)。两组比较发现急性生理学与慢性健康状况评分(APACHEII)、白蛋白(ALB)、C反应蛋白(CRP)、降钙素原(PCT)差异有统计学意义(均P<0.05);单因素结果显示使用肠外营养、使用抑酸护胃药、碳青霉烯类使用、头孢类或酶抑制剂使用、应用气管镜、机械通气及中心静脉置管均是MDR-KPN感染的危险因素;Logistic多因素分析及ROC曲线结果显示RICU住院时间、APACHEII评分、中心静脉置管、碳青霉烯类使用、机械通气是MDR-KPN肺炎的独立危险因素,且能准确预测临床MDR-KPN肺炎的发生。结论缩短住院时间、减少机械通气时间、减少中心静脉置管时间、控制APACHEII评分、减少碳青霉烯类药物使用可减少MDR-KPN肺炎的发生。Objective Analyze the risk and prognostic factors Multidrug-resistant Klebsiella pneumoniae(MDR-KPN)in patients with pneumonia in Respiratory Intensive Care Unit(RICU),in order to reduce clinical drug resistance provides guidance significance.Methods The data of 108 cases of MDR-KPN in patients with pneumonia were analyzed from Jan 2021 to Apr 2023 in RICU of The Second People Hospital of Hefei.The patients were divided into two groups(MDR-KPN and non-MDR-KPN)according to the sputum culture.The prediction model was established according to the results of logistic regression analysis.Results Comparing the groups found APACHE II scores,albumin,c-reactive protein,procalcitonin difference was statistically significant(P<0.05).Univariate analysis suggested the use of parenteral nutrition,use acid suppression,protecting stomach medicine,carbon penicillium used alkene,cephalosporins,or enzyme inhibitors,application of bronchoscope,mechanical ventilation and center venipuncture were the risk factors of MDR-KPN infection.Multivariate Logistic regression analysis and ROC revealed that length of hospital stays in RICU,APACHE II scores,indwelling central venous catheter,carbapenems antibiotics used and mechanical ventilation were an Independent factor of MDR-KPN infection,and could accurately predict the occurrence of clinical MDR-KPN pneumonia.Conclusion Short hospital stay,reduced mechanical ventilation time,reduced central vein catheterization time,controlled APACHEII score,and reduced carbapenem use could reduce the occurrence of MDR-KPN pneumonia.

关 键 词：肺炎克雷伯杆菌 多重耐药 肺炎 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]