血流感染耐碳青霉烯类肺炎克雷伯菌患者的死亡危险因素分析

Analysis of risk factors for mortality in patients with bloodstream infection of Carbapenem-resistant Klebsiella pneumonia

目的:分析耐碳青霉烯类肺炎克雷伯菌(Carbapenem-resistant Klebsiella pneumonia,CRKP)血流感染患者的临床特征和死亡危险因素。方法:回顾性分析上海交通大学医学院附属瑞金医院2017年1月至2019年6月CRKP血流感染的电子病历,根据感染后30 d预后情况分为生存组和死亡组,分析其临床特征和死亡危险因素。结果:共纳入74例CRKP血流感染患者,总死亡率为55.4%。30 d内死亡的独立危险因素是急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分≥16.5分[优势比(odds ratio,OR)=1.118,95%置信区间(confidence interval,CI):1.012~1.236,P=0.029]、感染性休克(OR=12.52,95%CI:3.002~52.227,P=0.001)。结论:CRKP血流感染患者的死亡率较高,APACHEⅡ评分越高,死亡风险越大,评分每增加1分,死亡风险增加11.8%。出现感染性休克的死亡风险是无感染性休克患者的12.52倍。

Objective:To evaluate the clinical characteristics and risk factors for mortality of bloodstream infections of Carbapenem-resistant Klebsiella pneumonia(CRKP).Methods The electronic medical records of the patients with CRKP bloodstream infection in Ruijin hospital in Shanghai from January 2017 to June 2019 were reviewed and analyzed retrospectively.The patients were divided into survival group and death group according to the clinical endpoint of 30 d after infection,and their clinical characteristics and risk factors for mortality were analyzed.Results A total of 74 patients with CRKP bloodstream infection were enrolled,and the mortality rate was 55.4%.The independent risk factors for mortality within 30 d were acute physiology and chronic health evaluation(APACHE) Ⅱ score≥16.5[odds ratio(OR)=1.118,95%confidence interval(CI):1.012-1.236,P=0.029],and septic shock(OR=1.52,95%CI:3.002-52.227,P=0.001).Conclusions The patients with CRKP bloodstream infection have a high mortality rate.The higher APACHE Ⅱ score is,the greater risk of mortality will be.For each additional point in the score,the risk of death increased 11.8%.The risk of death in the patients with septic shock is 12.52 times higher than that in higher than without septic shock.