耐碳青霉烯类革兰阴性菌肺炎的发生及死亡风险因素分析

Risk factors for Carbapenem-resistant and mortality in inpatients with pneumonia due to gram-negative bacteria

目的探讨影响耐碳青霉烯类革兰阴性菌(CR-GNB)肺炎发生及其死亡的风险因素,为临床经验性诊治和预防提供参考。方法回顾性分析2016年1月至12月226例革兰阴性菌肺炎住院患者,根据药敏结果分为碳青霉烯类耐药组114例和非耐药组112例,根据预后将耐药组分为存活组88例和死亡组26例。采取单因素及多因素分析,确定引起CR-GNB肺炎发生及死亡的独立危险因素。结果单因素分析显示,入住ICU、近期手术、长期卧床、发热、意识障碍、90天内使用碳青霉烯类抗生素、呼吸衰竭、休克、感染前有创操作、感染病原菌(ABA、SMA)、院内获得,在耐药组的比例明显高于非耐药组;入住ICU、冠心病、糖尿病、肾功能不全、呼吸衰竭、休克、留置导尿、深静脉置管、机械通气,在死亡组的比例明显高于存活组。多因素分析显示,之前90天内应用碳青霉烯类抗生素以及机械通气、鲍曼不动杆菌感染、院内获得的患者发生CR-GNB肺炎的风险增加。休克、深静脉置管、糖尿病、冠心病的CR-GNB肺炎患者死亡风险增加。结论之前90天内应用碳青霉烯类抗生素以及机械通气、鲍曼不动杆菌感染、院内获得是发生CR-GNB肺炎的独立危险因素;休克、深静脉置管、糖尿病、冠心病是其死亡的独立危险因素。

Objective To explore the risk factors and its related prognostic factors of the pneumonia caused by Carbapenem-resistant gram-negative bacteria(CR-GNB). Methods We retrospectively analyzed the clinical materials of patients diagnosed by gram-negative bacteria pneumonia in 2016. According to the sputum or bronchoalveolar lavage fluid(BALF) culture results, patients were divided into CR-GNB group ( n =114) and nCR-GNB group ( n =112). We further divided CR-GNB group into survived ( n =88) and died ( n =26) in terms of patients' 30 day prognosis.We conducted the statistical analysis using univariate analysis and multivariate analysis to identify independent risk factors for CR-GNB and associated mortability in pneumonia patients. Results Univariate analysis revealed that eleven factors were associated with the pneumoniae caused by CR-GNB, including ICU stay, recent history of surgery, bed-ridden, fever, conscious disturbance, carbapenem antibiotics application in past 90 days, respiratory failure, shock, invasive manipulation, ABA and SMA infection, hospital acquired. ICU stay, coronary heart disease, diabetes mellitus, renal failure, respiratory failure, shock, retention catheterization, deep vein catheterization and mechanical ventilation were associated with the mortality of CR-GNB pneumonia. Multivariate analysis showed that Carbapenem antibiotics application in past 90 days, mechanical ventilation, ABA infection and hospital acquired is independent risk factor of CR-GNB. Furthermore, shock, deep vein catheterization, diabetes mellitus and coronary heart diseases were independently associated with mortality of CR-GNB pneumonia. Conclusion Carbapenem antibiotics application in past 90 days, mechanical ventilation, ABA infection and hospital acquired is independent risk factor of CR-GNB. Furthermore, shock, deep vein catheterization, diabetes mellitus and coronary heart diseases were independently associated with mortality of CR-GNB pneumonia.