老年呼吸衰竭患者碳青霉烯耐药肺炎克雷伯菌感染的临床特征及危险因素分析  

Clinical characteristics and risk factors for Carbapenem-resistant Klebsiella pneumoniae infection in elderly patients with respiratory failure

作　　者：王伟飞 袁锐 郑君刚 李丹辉 夏叶子 马倩倩 姚麒[1] WANG Weifei;YUAN Rui;ZHENG Jungang;LI Danhui;XIA Yezi;MA Qianqian;YAO Qi(Department of Geriatrics,the First Affiliated Hospital of Ningbo University,Ningbo 315010,China;不详)

机构地区：[1]宁波大学附属第一医院老年医学科,315010 [2]宁波大学附属第一医院麻醉科,315010 [3]宁波大学附属第一医院重症医学科,315010 [4]宁波大学医学部

出　　处：《浙江医学》2025年第8期849-854,共6页Zhejiang Medical Journal

摘　　要：目的探讨老年呼吸衰竭患者碳青霉烯耐药肺炎克雷伯菌(CRKP)感染的临床特征及危险因素。方法回顾性选取2022年1至12月宁波大学附属第一医院收治的肺炎克雷伯菌感染的老年呼吸衰竭患者157例为研究对象,其中CRKP感染85例(CRKP感染组),碳青霉烯敏感肺炎克雷伯菌(CSKP)感染72例(CSKP感染组)。比较两组患者临床特征,并采用多因素logistic回归分析老年呼吸衰竭患者发生CRKP感染的危险因素。结果老年呼吸衰竭患者痰液等标本中分离出的CRKP对头孢类抗菌药物(头孢吡肟、头孢曲松、头孢呋辛酯、头孢呋辛)、β内酰胺酶抑制剂组合类抗菌药物(哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、阿莫西林/克拉维酸)、碳青霉烯类抗菌药物(亚胺培南、厄他培南)耐药率较高(均>50%)。CRKP感染组患者中性粒细胞百分比、降钙素原和D-二聚体水平、既往有血液病史及进行过气管插管、气管切开、腰椎穿刺、纤维支气管镜、深静脉穿刺置管等侵入性操作比例、临床肺部感染评分、住院总费用和不良预后比例均高于CSKP感染组,血红蛋白(Hb)水平、既往有恶性肿瘤病史比例均低于CSKP感染组,住院总时长长于CSKP感染组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示低Hb水平、既往有血液病史、气管切开均是老年呼吸衰竭患者发生CRKP感染的危险因素(OR=1.039、4.197、7.193,均P<0.05)。结论CRKP耐药形势严峻,低Hb水平、气管切开及既往有血液病史均是老年呼吸衰竭患者CRKP感染的主要危险因素。临床应重视Hb监测,强化有血液病史和气管切开史患者的感染防控,以降低CRKP感染风险。Objective To explore the clinical characteristics and risk factors for Carbapenem-resistant Klebsiella pneumoniae(CRKP)infection in elderly patients with respiratory failure.Methods A total of 157 elderly patients with respiratory failure who were infected with Klebsiella pneumoniae and admitted to the First Affiliated Hospital of Ningbo University from January to December 2022 were retrospectively selected as the research objects.Among them,85 cases had CRKP infection(CRKP infection group),and 72 cases had Carbapenem-sensitive Klebsiella pneumoniae(CSKP)infection(CSKP infection group).The clinical characteristics of the two groups of patients were compared,and multivariate logistic regression analysis was used to analyze the risk factors for CRKP infection in elderly patients with respiratory failure.Results The CRKP isolated from specimens such as sputum of elderly patients with respiratory failure had a high resistance rate to cephalosporin antibiotics(cefepime,ceftriaxone,cefuroxime axetil,and cefuroxime),β-lactamase inhibitor combination antibacterial drugs(piperacillin/tazobactam,cefoperazone/sulbactam,and amoxicillin/clavulanic acid),and carbapenem antibacterial drugs(imipenem,and ertapenem)(all>50%).Compared with CSKP infection group,the CRKP infection group had higher percentage of neutrophils,levels of procalcitonin and D-dimer,larger proportions of patients with a history of hematological diseases and those who had received invasive procedures such as tracheal intubation,tracheotomy,lumbar puncture,fiberoptic bronchoscopy,and deep vein puncture and catheterization,and higher clinical pulmonary infection score,total hospitalization cost and proportion of poor prognosis,while the CRKP infection group demonstrated lower hemoglobin(Hb)level and proportion of patients with a history of malignant tumors,and longer total length of hospital stay,the differences of which were all statistically significant(all P<0.05).Multivariate logistic regression analysis showed that low Hb level,a history of hematological

关 键 词：碳青霉烯耐药肺炎克雷伯菌 老年呼吸衰竭 临床特征 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]