耐碳青霉烯肺炎克雷伯菌肺炎患者死亡相关因素分析

Analysis of mortality-related factors in pneumonia patients with carbapenem-resistant Klebsiella pneumoniae infection

目的研究耐碳青霉烯肺炎克雷伯菌(CRKP)肺炎患者死亡情况及危险因素,及不同治疗方案对预后的影响。方法回顾性分析北京大学第三医院痰培养为CRKP的病例,收集临床资料,筛选诊断肺炎者,用Logistic回归分析死亡相关危险因素,Kaplan-Meier生存曲线分析不同治疗方案死亡率差异。结果将53例CRKP肺炎患者纳入本研究,30 d内死亡率为24.5%。多因素回归分析显示,合并肾功能不全是死亡的独立危险因素(OR=6.87,P<0.05)。生存分析显示,与单用β-内酰胺类药物相比,β-内酰胺类与其他种类抗菌药物的联合治疗方案死亡率减低,差异有统计学意义(P<0.05)。结论合并肾功能不全是CRKP肺炎死亡的独立危险因素。对CRKP肺炎患者,应用多种抗菌药物联合治疗。在没有替加环素或多黏菌素的情况下,推荐联合氨基糖苷类药物。

Objective To retrospectively investigate risk factors associated with mortality of pneumonia patients caused by carbapenem-resistant Klebsiella pneumoniae（ CRKP）,and impact of different antibiotic regimens on the patients＇ prognosis. Methods This was a retrospective study of hospitalized patients who were diagnosed with pneumonia and had sputum culture identified as CRKP in Peking University Third Hospital. We reviewed medical record and microbiological data of qualified patients. Logistic regression was applied to identify risk factors of mortality,and Kaplan-Meier survival analysis was used to compare different antibiotic regimens. Results Fifty-three patients with CRKP pneumonia were enrolled in this study,with a 30 d mortality rate of 24. 5%. Multivariate regression analysis showed renal insufficiency as an independent factor of mortality（ OR = 6. 87,P〈0. 05）. Survival analysis showed that combination treatments significantly reduce mortality rate compared to β-lactam monotherapy. Conclusion Concomitant renal insufficiency is an independent factor of mortality. Combination therapy should be given in pneumonia patients with CRKP infection. In circumstance of lacking tigecycline or colistin,it is suggested to add glycopeptide in the regimen to reduce mortality.