难治性耐药肺炎克雷伯菌血流感染的危险因素及预后  

Risk factors and prognosis of difficult-to-treat resistance Klebsiella pneumoniae bloodstream infection

作　　者：蔡依含 黄雅轩 张莉滟 赵越 CAI Yihan;HUANG Yaxuan;ZHANG Liyan;ZHAO Yue(Department of Clinical Laboratory,Xiaolan People's Hospital of Zhongshan,the Fifth People's Hospital of Zhongshan,Zhongshan,Guangdong 528415,China;Department of Clinical Laboratory,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Southern Medical University,Guangzhou,Guangdong 510080,China)

机构地区：[1]中山市小榄人民医院,中山市第五人民医院检验科,广东中山528415 [2]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

出　　处：《热带医学杂志》2025年第2期220-223,共4页Journal of Tropical Medicine

基　　金：广东省基础与应用基础研究基金(2021A1515220022)。

摘　　要：目的探讨医院内难治性耐药肺炎克雷伯菌(DTR-KP)血流感染患者的临床危险因素及预后情况,为临床及时遏制其流行,改善患者预后提供依据。方法收集广东省人民医院2018年1月-2023年6月临床已确诊为DTR-KP血流感染患者病历资料50例,采用病例-对照1∶2研究方法,随机选取同期被诊断为非DTR-KP所致血流感染的患者资料100例,运用单因素及多因素logistic回归分析DTR-KP血流感染患者的临床危险因素,采用χ^(2)检验分析患者临床预后情况。结果DTR-KP血流感染患者年龄中位数为64岁,主要分布于重症监护室、老年医学科、新生儿科。两组患者在伴有血液系统疾病(χ^(2)=5.081,P=0.024)、合并3种及以上基础疾病(χ^(2)=9.949,P=0.002)、入住ICU>7 d(χ^(2)=8.824,P=0.003)、中心静脉插管(χ^(2)=8.036,P=0.005)、机械通气(χ^(2)=4.216,P=0.040)、使用β-内酰胺酶抑制剂(χ^(2)=8.517,P=0.004)和糖皮质激素(χ^(2)=3.898,P=0.048)等方面的比较差异均有统计学意义。Logistic回归分析结果显示,患者伴有血液系统疾病(OR=3.935,P=0.017)、合并3种及以上基础疾病(OR=3.389,P=0.004)、入住ICU>7 d(OR=3.970,P=0.003)和中心静脉插管(OR=6.809,P=0.026)可能是导致DTR-KP血流感染发生的重要危险因素。DTR-KP血流感染患者死亡率高于对照组,差异有统计学意义(χ^(2)=25.729,P<0.001)。结论DTR-KP血流感染患者预后较差,临床需提高对其的认知能力与防控意识,通过采取主动筛查等措施,进而有效减少DTR-KP血流感染的发生。Objective To investigate the clinical risk factors and prognosis of patients with difficult-to-treat drug resistance Klebsiella pneumoniae(DTR-KP)bloodstream infection in hospital,and provide a basis for timely containment of the DTRKP epidemic and improvement of patient prognosis.Methods The clinical data of 50 patients diagnosed with DTR-KP bloodstream infection were collected in the Guangdong Provincial People's Hospital from January 2018 to June 2023.100patients diagnosed with bloodstream infections with non-DTR-KP were randomly selected by means of case-control study in a 1∶2 ratio during the same period.The clinical risk factors of patients with DTR-KP bloodstream infections were analyzed by univariate analysis and multiple logistic regression analysis,and clinical prognosis of patients was analyzed by χ^(2) test.Results The median age of patients with DTR-KP bloodstream infection was 64-years-old,mainly distributed in intensive care unit,department of geriatrics and neonatology.The two groups of patients showed statistical differences in various aspects including hematological diseases(χ^(2)=5.081,P=0.024),comorbidities with three or more underlying diseases(χ^(2)=9.949,P=0.002),ICU stay exceeding 7 days(χ^(2)=8.824,P=0.003),central venous catheterization(χ^(2)=8.036,P=0.005),mechanical ventilation(χ^(2)=4.216,P=0.040),use of β-lactamase inhibitors(χ^(2)=8.517,P=0.004),and glucocorticoids(χ^(2)=3.898,P=0.048).The results of logistic regression analysis showed that patients with hematological disorders(OR=3.935,P=0.017),comorbidities with three or more underlying diseases(OR=3.389,P=0.004),ICU stay exceeding 7 days(OR=3.970,P=0.003),and central venous catheterization(OR=6.809,P=0.026)might be important risk factors for DTR-KP bloodstream infection.Mortality rate of patients with DTR-KP bloodstream infection was higher than that of control group(χ^(2)=25.729,P<0.001).Conclusions awareness of DTR-KP bloodstream infection needed to be improved.The occurrence of DTR-KP bloodstream infection could be

关 键 词：难治性耐药肺炎克雷伯菌 血流感染 危险因素 临床预后 

分 类 号：R446.5[医药卫生—诊断学]