ICU获得性耐药肺炎克雷伯杆菌血流感染的临床特征及危险因素分析

Clinical characteristics and risk factors of antibiotic resistant klebsiella pneumoniae bloodstream infection acquired in ICU

目的了解医院重症监护室(ICU)获得性耐药肺炎克雷伯杆菌血流感染的临床特征,并探讨其危险因素。方法搜集2013年1月至2017年12月郑州大学第二附属医院ICU获得性肺炎克雷伯杆菌血流感染者73例,纳入符合标准的65例,其中耐药性肺炎克雷伯杆菌血流感染30例,非耐药的肺炎克雷伯杆菌血流感染35例。统计其相关临床特征,并进行Logistic回归分析,得出其危险因素。结果ICU获得性耐药性肺炎克雷伯杆菌血流感染以男性、高龄患者居多,且大部分患者合并多种基础疾病、感染,使用较多抗生素,入住ICU时间较长,接受较多侵入性操作,使用人工气道、呼吸机等。单因素回归分析提示患者自身基础疾病数目(P=0.046)、入住ICU时间(P=0.007)、合并其他感染(P=0.042)、使用抗生素的数目(P=0.002)及时间(P=0.013)、人工气道(P=0.033)、纤维支气管应用(P=0.037)、呼吸机应用(P=0.021)以及侵入性操作(P=0.001)为ICU获得性耐药肺炎克雷伯杆菌血流感染的危险因素。进一步行Logistic回归分析提示,入住ICU的时间(P=0.036)、抗生素使用数目(P=0.017)及时间(P=0.019)、人工气道(P=0.022)、呼吸机应用(P=0.036)以及侵入性操作(P=0.008)为易感的独立危险因素。结论ICU获得性耐药肺炎克雷伯杆菌血流感染日益严重,与患者长时间入住ICU,长时间使用或联合使用抗生素,使用人工气道、呼吸机,以及接受侵入性操作有关。

Objective To study the clinical features of antibiotic resistant Klebsiella pneumoniae bloodstream infection acquired in intensive care unit(ICU),and further to investigate its risk factors.Methods The 73 patients with Klebsiella pneumoniae bloodstream infections acquired in ICU from January 2013 to December 2017 in the Second Affiliated Hospital of Zhengzhou University were collected.A total of 65 cases of Klebsiella pneumoniae bloodstream infections were collected in this study.Thirty antibiotic resistant Klebsiella pneumoniae bloodstream infections and 35 non-resistant Klebsiella pneumoniae bloodstream infections were included.Statistical analysis on the clinical characteristics of eligible cases and Logistic regression analysis were conducted to identify the risk factors.Results The statistical results showed that the ICU-acquired antibiotic resistant Klebsiella pneumoniae bloodstream infections were mostly in male and elderly patients,and most of them were complicated by multiple basic diseases and infection,frequently used antibiotics,stayed in ICU for long term or received invasive operations,such as artificial airways,ventilators,etc.Univariate regression analysis showed that the number of diseases patients underlying(P=0.046),duration of ICU(P=0.007),other infections(P=0.042),the number and days of antibiotics used(P=0.002,0.013),artificial airway(P=0.033),application of fiberbronchoscope(P=0.037),use of ventilator(P=0.021),and invasive operation(P=0.001)were the risk factors for acquired drug-resistant Klebsiella pneumoniae bloodstream infection in ICU.Further Logistic regression analysis showed that the duration of ICU(P=0.036),the number and days of antibiotics used(P=0.017,0.019),artificial airway(P=0.022),ventilator application(P=0.036)and invasive procedures(P=0.008)were independent risk factors for susceptibility.Conclusions Exacerbation of acquired drug-resistant Klebsiella pneumoniae bloodstream infection acquired in ICU is associated with the prolonged stay in the ICU,long-term or combined use of antibiotics,use of artificial airway,ventilator and invasive operation.