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周君辰, 李娟, 董爱英, 周海健, 薛佳琦, 段立科, 施淇源, 刘泽梁, 高鹏芳, 韩肖. 碳青霉烯耐药肺炎克雷伯菌血流感染的危险因素分析[J]. 疾病监测, 2022, 37(3): 356-360. DOI: 10.3784/jbjc.202107080390
引用本文: 周君辰, 李娟, 董爱英, 周海健, 薛佳琦, 段立科, 施淇源, 刘泽梁, 高鹏芳, 韩肖. 碳青霉烯耐药肺炎克雷伯菌血流感染的危险因素分析[J]. 疾病监测, 2022, 37(3): 356-360. DOI: 10.3784/jbjc.202107080390
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Zhou Junchen, Li Juan, Dong Aiying, Zhou Haijian, Xue Jiaqi, Duan Like, Shi Qiyuan, Liu Zeliang, Gao Pengfang, Han Xiao. Risk factors of bloodstream infection of carbapenem-resistant Klebsiella pneumoniae[J]. Disease Surveillance, 2022, 37(3): 356-360. DOI: 10.3784/jbjc.202107080390
Citation: Zhou Junchen, Li Juan, Dong Aiying, Zhou Haijian, Xue Jiaqi, Duan Like, Shi Qiyuan, Liu Zeliang, Gao Pengfang, Han Xiao. Risk factors of bloodstream infection of carbapenem-resistant Klebsiella pneumoniae[J]. Disease Surveillance, 2022, 37(3): 356-360. DOI: 10.3784/jbjc.202107080390
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碳青霉烯耐药肺炎克雷伯菌血流感染的危险因素分析

Risk factors of bloodstream infection of carbapenem-resistant Klebsiella pneumoniae

    摘要
  • 摘要:
      目的  探讨耐碳青霉烯类肺炎克雷伯菌（CRKP）血流感染患者的多重危险因素，为临床诊疗和预防提供依据。
      方法  回顾性分析华北理工大学附属医院2013年1月至2020年12月确诊且病例资料完整的CRKP血流感染患者的临床资料（病例组），以同期感染碳青霉烯类敏感肺炎克雷伯菌（CSKP）的患者作为对照组，使用SPSS 23.0软件，对两组患者的一般临床特征进行单因素和多因素 logistic 回归分析，探寻血流感染CRKP患病的危险因素。
      结果  CRKP血流感染组患者的病死率明显高于CSKP血流感染组（χ2=31.396，P<0.001），差异有统计学意义；56例CRKP血流感染患者主要分布在重症监护病房（80.36%）；单因素分析表明低蛋白血症、感染前使用β-内酰胺类抗生素（除碳青霉烯类外）、感染前使用碳青霉烯类抗生素、感染前使用喹诺酮类抗生素、感染前使用激素、留置侵入性器械、留置中心静脉导管、留置胃管、留置尿管、呼吸机辅助机械通气以及感染前入住ICU在两组间差异有统计学意义（P<0.05）；二元logistic回归分析显示感染前使用碳青霉烯类抗生素（OR=26.310，P<0.001）、留置中心静脉导管（OR=9.534，P=0.035）是CRKP血流感染的独立危险因素。
      结论  血流感染CRKP的死亡率高，感染前使用碳青霉烯类抗生素和留置中心静脉导管提示患者预后差，建议加强抗菌药物的合理使用，加强院感防控意识。

     

    Abstract:
      Objective  To identify the multi-risk factors od bloodstream infection of carbapenem-resistant Klebsiella pneumoniae (CRKP), and provide evidence for the clinical diagnosis, treatment and prevention of infection disease.
      Methods   The retrospective analysis was carried out by using the clinical data of the bloodstream CRKP infection cases with completed medical records diagnosed in the affiliated hospital of North China University of Science and Technology from January 2013 to December 2020, the patients infected with carbapenem-sensitive Klebsiella pneumoniae (CSKP) during the same period were included as control group . Software SPSS 23.0 was used for univariate and multivariate analyses to identify the risk factors for bloodstream infection of CRKP.
      Results  The case fatality rate in bloodstream CRKP infection group was significantly higher than that in bloodstream CSKP infection group (χ2=31.396, P<0.001). The 56 patients with bloodstream CRKP infection were mainly distributed in intensive care unit (ICU) (80.36%). Univariate analysis indicated that the differences in prevalence of hypoproteinemia, uses of β-lactams (except carbapenems), carbapenem antibiotics, quinolone antibiotics and hormone before infection and the uses of indwelling invasive instruments, indwelling central catheter, indwelling stomach tube, indwelling catheter, ventilator assistance of mechanical ventilation and ICU stay before infection were significant between the two groups, (P<0.05). The binary logistic regression analysis showed that the use of carbapenem antibiotics (OR=26.310, P<0.001) and the use of indwelling central venous catheter (OR=9.534, P=0.035) before infection were the independent risk factors of bloodstream CRKP infection.
      Conclusion  The cases fatality of bloodstream CRKP infection was high. Using carbapenem antibiotics before infection and using indwelling central venous catheters often indicate poor prognosis. It is suggested to have a rational use of antibiotics and improve the prevention and control of nosocomial infection.

     

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