生物膜阳性肺炎克雷伯菌血流感染及预后危险因素分析

Risk factors for infection of biofilm-positive Klebsiella pneumonia and prognosis of patients

目的探究生物膜阳性肺炎克雷伯菌血流感染患者的感染及预后相关危险因素。方法回顾性分析天津医科大学总医院2019年1月至12月125例肺炎克雷伯菌血流感染患者的临床资料,根据肺炎克雷伯菌是否存在生物膜,将所有患者分为生物膜阳性组(n=81)和生物膜阴性组(n=44)。生物膜阳性组根据3个月预后分为死亡组(n=17)与存活组(n=64)。分析肺炎克雷伯菌的耐药情况,采用多因素Logistic回归分析生物膜阳性肺炎克雷伯菌血流感染及死亡的危险因素。结果125例患者共分离125株肺炎克雷伯菌,其中生物膜阳性81株(64.80%)。耐药性分析发现,生物膜阳性肺炎克雷伯菌对氨曲南、阿米卡星、环丙沙星及左氧氟沙星的耐药率均高于生物膜阴性菌(χ2=5.94、4.03、5.05和4.15,P<0.05)。多因素分析显示,感染前3个月内行气管插管(OR=3.460,95%CI 2.890~14.445,P<0.05)和应用免疫抑制剂(OR=6.945,95%CI 1.160~21.567,P<0.05)为生物膜阳性肺炎克雷伯菌血流感染的独立危险因素。死亡前3个月内使用替加环素(OR=4.886,95%CI 1.123~21.263,P<0.05)为生物膜阳性肺炎克雷伯菌血流感染患者死亡的独立危险因素。结论临床应合理应用抗菌药物,尽量减少有创操作,降低生物膜阳性肺炎克雷伯菌血流感染的发生率及病死率。

Objective To investigate risk factors for infection of biofilm-forming Klebsiella pneumonia and prognosis of patients.Methods The clinical data of 125 patients with Klebsiella pneumoniae bloodstream infection admitted in Tianjin Medical University General Hospital from January to December 2019 were analyzed retrospectively.According to the presence of Klebsiella pneumoniae biofilm,patients were divided into biofilm positive group(n=81)and biofim negative group(n=44).In biofilm positive group 17 patients died(fatal group)and 64 survived(survival group)during 3-month follow-up.The antimicrobial resistance of the strains was analyzed,and multivariate logistic regression analysis was used to investigate the risk factors of biofilm-forming Klebsiella pneumoniae infection and the risk factors of death in biofilm positive group.Results A total of 125 strains of Klebsiella pneumoniae were isolated from 125 patients,of which 81(64.80%)strains were biofilm positive.Antimicrobial resistance analysis showed that the resistance rate of biofilm positive group to aztreonam,amikacin,ciprofloxacin and levofloxacin was significantly higher than that in the biofilm negative group(χ2=5.94,4.03,5.05 and 4.15,P<0.05).Multivariate logistic regression analysis showed that endotracheal intubation(OR=3.460,95%CI 2.890-14.445,P<0.05)and administration of immunosuppressants(OR=6.945,95%CI 1.160-21.567,P<0.05)within 3 months before infection were independent risk factors for biofilm-forming Klebsiella pneumoniae bloodstream infection.The use of tegacycline(OR=4.886,95%CI 1.123-21.263,P<0.05)within 3 months before death was independent risk factors for the death of biofilm-positive Klebsiella pneumoniae bloodstream infection.Conclusions In order to reduce the incidence and fatality of biofilm-forming Klebsiella pneumoniae bloodstream infection,antibiotics should be used rationally and invasive procedures should be minimized.