烧伤伴肺炎克雷伯菌感染患者流行病学调查和发生脓毒症的危险因素分析

Epidemiological investigation of burn patients with Klebsiella pneumoniae infection and the analysis of risk factors for sepsis in them

目的分析2015—2017年浙江大学医学院附属第二医院烧伤科(以下称笔者科室)肺炎克雷伯菌(KP)感染的流行趋势并筛选烧伤伴KP感染患者发生脓毒症的独立危险因素。方法收集笔者科室2015年1月1日—2017年12月31日烧伤伴KP感染患者的临床资料和细菌学资料,统计分析3年间患者KP和抗碳青霉烯类抗生素KP(CRKP)感染率的变化趋势,对数据行χ^2检验。对临床资料进行二分类logisitic回归分析,筛选烧伤伴KP感染患者发生脓毒症的独立危险因素。结果(1)2015—2017年笔者科室确诊为KP感染的患者共91例(男50例、女41例,年龄15~90岁),其中CRKP阳性65例,碳青霉烯类抗生素敏感KP阳性26例。2015、2016、2017年患者KP感染率分别为5.79%(35/605)、4.08%(23/564)和5.54%(33/596),CRKP感染率分别为3.31%(20/605)、3.37%(19/564)和4.36%(26/596),不同年度间患者KP感染率和CRKP感染率差异均无统计学意义(χ^2=2.007、1.175,P>0.05)。(2)烧伤总面积和CRKP感染为烧伤伴KP感染患者发生脓毒症的独立危险因素(比值比=1.03、5.88,95%置信区间=1.01~1.05、1.08~31.94,P<0.05)。结论2015—2017年,笔者科室患者KP和CRKP感染率并未明显上升,但CRKP感染占比高。CRKP感染是烧伤伴KP感染患者发生脓毒症的独立危险因素之一,加强CRKP感染的防治对降低烧伤脓毒症发生率可能具有一定价值。

Objective To analyze the prevalence trend of Klebsiella pneumoniae(KP)infection in the Department of Burns of the Second Affiliated Hospital of Zhejiang University School of Medicine(hereinafter referred to as the author′s department)from 2015 to 2017,and to screen out the independent risk factors for sepsis in burn patients with KP infection.Methods The clinical and bacteriological data of burn patients with KP infection from January 1,2015 to December 31,2017 were collected from the author′s department.The variation trend in infection rates of KP and carbapenems-resistant KP(CRKP)during the three years were statistically analyzed,and the data were processed with chi-square test.Clinical data were processed with binary logistic regression analysis to screen out the independent risk factors for sepsis in burn patients with KP infection.Results(1)From 2015 to 2017,91 patients(50 males and 41 females,aged 15-90 years)with KP infection were diagnosed in the author′s department,of which 65 cases were CRKP positive,and 26 cases were carbapenems-sensitive KP positive.The KP infection rates of patients in 2015,2016,and 2017 were 5.79%(35/605),4.08%(23/564),and 5.54%(33/596),respectively.The CRKP infection rates of patients in 2015,2016,and 2017 were 3.31%(20/605),3.37%(19/564),and 4.36%(26/596),respectively.There were no statistically significant differences in KP infection rate and CRKP infection rate of patients among the three years(χ^2=2.007,1.175,P>0.05).(2)Total burn area and CRKP infection were independent risk factors for sepsis in burn patients with KP infection(odds ratios=1.03,5.88,95%confidence intervals=1.01-1.05,1.08-31.94,P<0.05).Conclusions From 2015 to 2017,the infection rates of KP and CRKP in the author′s department did not increase obviously,but the proportion of CRKP infection was high.CRKP infection is one of the independent risk factors for sepsis in burn patients with KP infection.Strengthening the prevention and treatment of CRKP infection may have certain value in decreasing the incidence of burn sepsis.