ICU内碳青霉烯类耐药肺炎克雷伯菌感染的危险因素及预测模型的建立

Risk factors and prediction model of carbapenem resistant Klebsiella pneumoniae infection in ICU

目的探讨重症监护室(Intensive Care Unit,ICU)内碳青霉烯类耐药肺炎克雷伯菌感染(carbapenem resistanceKlebsiella pneumoniae infection,CRKP)的危险因素并建立预测模型。方法选取2014年01月至2019年12月在我院ICU进行治疗的患者150例作为研究对象,根据其是否发生CRKP分为感染组(n=70)和未感染组(n=80)。分析影响ICU患者发生CRKP的危险因素,绘制预测ICU患者发生CRKP的ROC曲线。结果感染组患者的血清IL-6以及TNF-α水平明显高于未感染组且差异具有统计学意义(P<0.05)。抗菌药应用时间≥7天、是否运用过碳青霉烯类药物、机械通气时间≥7天、ICU住院天数≥5天、脑血管病病史、血清IL-6以及TNF-α表达,均是影响ICU患者发生CRKP的独立危险因素(P<0.05)。结论影响ICU住院患者发生CRKP的危险因素较多,包括抗菌药应用时间≥7天、是否运用过CB类药物、机械通气时间≥7天、ICU住院天数≥5天、脑血管病病史、血清IL-6以及TNF-α表达等。

Objective To investigate the risk factors of Carbapenem resistant bsiella pneumoniae infection(CRKP) in Intensive Care Unit(ICU) and to establish a prediction model. Methods 150 patients who were treated in ICU of our hospital from January 2014 to December 2019 were selected as the research objects, and they were divided into the infected group(n=70) and the uninfected group(n=80) according to their occurrence of CRKP. The risk factors affecting the occurrence of CRKP in ICU patients were analyzed, and the ROC curve for predicting the occurrence of CRKP in ICU patients was drawn. Results The serum IL-6 and TNF-α levels of the infected group were significantly higher than those of the uninfected group(P<0.05). Antimicrobial application time ≥7 days, whether carbapenem drugs used, mechanical ventilation time ≥7 days, ICU hospital stay ≥5 days, history of cerebrovascular disease, serum IL-6 and TNF-α expression were all affected the independent risk factors for CRKP in ICU patients(P<0.05). Conclusion There are many risk factors that affect the occurrence of CRKP in ICU inpatients, including antimicrobial application time ≥ 7 days, whether CB drugs have been used, mechanical ventilation time ≥ 7 days, ICU hospital stay ≥ 5 days, history of cerebrovascular disease, and serum IL-6 and TNF-α expression and so on.