感染耐碳青霉烯类抗生素的肺炎克雷伯菌患者死亡危险因素分析

Analysis on risk factors of death in patients with carbapenem resistant Klebsiella pneumonia

目的探讨感染对碳青霉烯类抗生素耐药的肺炎克雷伯菌(CRKP)患者的死亡危险因素。方法回顾性分析无锡市第二人民医院2012年1月—2015年12月期间住院的70例感染CRKP患者的病例资料。通过χ~2检验等方法确定CRKP产生的危险因素,通过logistic回归确定CRKP感染患者死亡的危险因素。结果 CRKP组患者急性生理与慢性健康(APACHEⅡ)评分、呼吸道感染、机械通气、重大手术、头孢哌酮/舒巴坦钠、入住ICU的比例明显高于对碳青霉烯类抗生素敏感的肺炎克雷伯菌(CSKP)组患者(均P<0.05)。单因素logistic回归分析发现,呼吸道感染、重大手术、机械通气、头孢哌酮/舒巴坦钠、入住ICU是CRKP感染患者死亡的危险因素(P<0.05)。多因素logistic回归分析发现,头孢哌酮/舒巴坦钠是CRKP感染患者死亡的独立危险因素。结论 CRKP感染患者死亡的危险因素为头孢哌酮/舒巴坦钠。因此避免或减少上述危险因素是降低CRKP感染患者死亡率的有效方法之一。

[Objective] To discuss the risk factors of death caused by carbapenem resistant Klebsiella pneumoniae（CRKP）infection. [Methods]The data of 70 patients with CRKP infection,who were treated in the Second People＇s Hospital of Wuxi from January 2012 to December 2015,were retrospectively analyzed. The risk factors of CRKP were determined by χ~2 test,and the risk factors of death in patients with CRKP infection were determined by logistic regression analysis.[Results]The score of acute physiology and chronic health evaluation（APACHE Ⅱ）,and the proportion of respiratory tract infection,mechanical ventilation,major surgery,cefoperazone plus sulbactam,and be admitted to ICU in CRKP group were higher than those in carbapenem antibiotic-sensitive Klebsiella pneumonia（CSKP） group（all P〈 0.05）. Single-factor logistic regression analysis indicated that respiratory tract infection,major surgery,mechanical ventilation,cefoperazone plus sulbactam,and be admitted to ICU were risk factors for death in patients with CRKP infection（P〈 0.05）. Multivariate logistic regression analysis found that cefoperazone plus sulbactam was the independent risk factor for death in patients with CRKP infection. [Conclusion]The risk factor for death in patients with CRKP infection is cefoperazone plus sulbactam. Thus avoiding or reducing the above risk factor is one of the effective ways to reduce the mortality of patients with CRKP infection.