中国成人重症加强治疗病房肺炎克雷伯菌感染现况分析:一项全国多中心队列研究  

Clinical characteristics of Klebsiella pneumoniae in adult intensive care unit:a nationwide multi-center cohort study in China

作　　者：杨曙光[1] 孙瑶 王婷[1] 张华[2] 孙薇[3] 安友仲[1] 赵慧颖[1] Yang Shu-Guang;Sun Yao;Wang Ting;Zhang Hua;Sun Wei;An You-Zhong;Zhao Hui-Ying(Department of Critical Care Medicine,Peking University People's Hospital,Beijing 100044,China;Research Center of Clinical Epidemiology,Peking University Third Hospital,Beijing 100191,China;Department of Critical Care Medicine,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学人民医院重症医学科,北京100044 [2]北京大学第三医院临床流行病学研究中心,北京100191 [3]北京大学国际医院重症医学科,北京102206

出　　处：《解放军医学杂志》2025年第3期292-300,共9页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金(82202366)。

摘　　要：目的 分析重症监护病房(ICU)住院患者肺炎克雷伯菌感染的分布、微生物学特点、耐药情况和死亡危险因素。方法 本研究为多中心前瞻性队列研究。收集2021年7月1日-2022年12月31日全国16个省(直辖市)67家有ICU科室的医院在ICU住院期间可疑感染患者的临床资料及微生物检测结果,根据患者的存活情况和耐药情况进行分组。采用单因素和多因素logistic回归分析ICU肺炎克雷伯菌感染患者的死亡危险因素和耐药危险因素。结果 共纳入2964例ICU感染患者,送检微生物标本12 175份,检出肺炎克雷伯菌487份;最终确定314例肺炎克雷伯菌感染患者,主要来源于肺部感染,耐药率为78.3%。在ICU住院期间,肺炎克雷伯菌感染患者的病死率为19.8%。单因素和多因素logistic回归分析显示,年龄大(P=0.027)、耐药率高(P=0.028)和临床有效率低(P<0.001)是ICU肺炎克雷伯菌感染患者死亡的独立危险因素。耐药分析显示,与未发生耐药者比较,发生耐药的ICU肺炎克雷伯菌感染患者的致病菌清除率(P=0.003)、临床有效率(P=0.004)、抗生素有效率(P<0.010)较低,病死率较高(P=0.006);肺炎克雷伯菌腹腔感染(P=0.003)和尿路感染(P=0.007)者的耐药发生率较高。肺部感染肺炎克雷伯菌患者的临床有效率、肺炎克雷伯菌清除情况、耐药率、病死率及住院时间与非肺部感染肺炎克雷伯菌者比较差异无统计学意义(P>0.05)。与非血流感染者比较,血流感染肺炎克雷伯菌的患者临床有效率较低(P=0.027)、病死率较高(P=0.021)。结论 年龄大、耐药率高和临床有效率低是ICU肺炎克雷伯菌感染患者死亡的独立危险因素。血流感染肺炎克雷伯菌的ICU患者临床有效率较低、病死率较高。腹腔及尿路感染肺炎克雷伯菌的ICU患者更易发生耐药。Objective To analyze the epidemiological distribution,microbiological characteristics,drug-resistance status,and risk factors for mortality in adult intensive care unit(ICU)patients with Klebsiella pneumoniae infection.Methods This multi-center prospective cohort study included ICU patients with suspected infection from 67 hospitals across 16 Chinese provinces/municipalities between July 1,2021 and December 31,2022.Clinical data and microbiological results were collected,and patients were divided into survival and non-survival groups according to their survival status and drug-resistance situation.Risk factors for mortality and drug resistance in ICU patients with Klebsiella pneumonia infection were determined through univariate and multivariate logistic regression analyses.Results A total of 2964 ICU-infected patients were enrolled,with 12175 microbial specimens submitted for testing.Among these,487 specimens tested positive for Klebsiella pneumoniae.Ultimately,314 patients with Klebsiella pneumoniae infection were identified,primarily from lung infections,with a drug-resistance rate of 78.3%.The in-hospital mortality rate of ICU patients infected with Klebsiella pneumoniae was 19.8%.Univariate and multivariate logistic regression analyses revealed that older age(P=0.027),high drug-resistance rate(P=0.028),and low clinical-effectiveness rate(P<0.001)were independent risk factors for mortality in ICU patients infected with Klebsiella pneumoniae.Drug-resistance analysis showed that,compared with non-resistant cases,ICU patients with drug-resistant Klebsiella pneumoniae infection had lower pathogen-clearance rates(P=0.003),clinical-effectiveness rates(P=0.004),and antibiotic-effectiveness rates(P<0.010),and higher mortality rates(P=0.006).Patients with Klebsiella pneumoniae abdominal infection(P=0.003)and urinary tract infection(P=0.007)had higher drug-resistance incidences.There were no statistically significant differences in clinical-effectiveness rate,Klebsiella pneumoniae clearance,drug-resistance incidence,mo

关 键 词：重症监护病房 感染 肺炎克雷伯菌 

分 类 号：R563[医药卫生—呼吸系统]