碳青酶烯类治疗重症下呼吸道感染继发二重感染危险因素分析

Risk Factor Analysis of Superinfection Following Carbapenems Therapy in Patients with Severe Lower Respiratory Tract Infection

目的探讨碳青酶烯类治疗重症下呼吸道感染继发二重感染的高危因素,为临床预测并减少二重感染提供参考。方法汇总重症下呼吸道感染经碳青酶烯类治疗5d以上者的临床资料,分析与二重感染相关的危险因素。结果本组入选53例,碳青酶烯类治疗后病情明显改善43例,占81.1%,38例存在二重感染危险因素,其中11例发生二重感染,感染率28.9%。经Pearson相关分析,与二重感染相关的5个变量分别为年龄(r=0.412,P=0.010)、机械通气(r=0.673,P=0.000)、低蛋白血症(r=-0.769,P=0.000)、碳青酶烯类治疗时间(r=0.843,P=0.000)、危重患者急性生理学与慢性健康评定标准Ⅱ(APACHEⅡ)评分(r=0.815,P=0.000)。结论机械通气、低蛋白血症、碳青酶烯类治疗时间、APACHEⅡ评分是碳青酶烯类治疗重症下呼吸道感染后继发二重感染的高危因素。

Objective To discuss the high risk factors of superinfection after carbapenems in treatment of patients with severe lower respiratory tract infection,and provide reference for prediction and reduction of superinfection.Methods The clinical data of severe lower respiratory tract infection patients treated by carbapenems for more than 5 d were selected,and the risk factors associated with the superinfection were analyzed.Results 53 patients were enrolled in the group.Pathogenetic conditions in 43 patients（81.1%）significantly improved after carbapenems treatment,and 38 patients had risk factors of superinfection,among whom 11 patients had superinfection with a 28.9% superinfection rate.In Pearson correlation analysis,the 5 factors closely related with superinfection were age（r=0.412,P=0.010）,mechanical ventilation（r=0.673,P=0.000）,hypoproteinemia（r=-0.769,P=0.000）,carbapenems treatment time（r=0.843,P=0.000）,acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）Score of critical patients（r=0.815,P=0.000）.Conclusion Mechanical ventilation,hypoproteinemia,carbapenems treatment time and APACHE Ⅱ score are high risk factors of superinfection after carbapenems treatment in patients with severe lower respiratory tract infection.