神经外科重症监护病房患者呼吸道感染产碳青霉烯酶肺炎克雷伯菌的预后分析

Prognostic analysis of patients with respiratory tract infection by KPC-producing Klebsiella Pneumoniae in neurosurgery intensive care unit

目的研究神经外科重症监护病房(NICU)呼吸道感染KPC-Kp患者的预后影响因素。方法对某三甲医院2017年1月-2019年3月NICU呼吸道感染KPC-Kp患者的临床资料进行分析,预后相关因素采用单因素分析及多因素Logistic分析。结果单因素分析显示,患者年龄>70岁、ICU住院天数、呼吸机使用情况、出血性脑卒中、癫痫、心功能不全、肾功能不全、消化道出血、胰腺炎、电解质紊乱、凝血功能异常以及替加环素的使用,是NICU呼吸道感染KPC-Kp患者死亡的相关因素;多因素Logistic分析显示,心功能不全、年龄>70岁、使用替加环素是NICU呼吸道感染KPC-Kp患者死亡的独立危险因素。结论对于高龄、心肾功能不良患者,临床应合理用药,改善患者预后,控制KPC-Kp的院内流行,降低NICU患者KPC-Kp的感染与死亡率。

Objective To study the prognostic factors of patients with respiratory tract infection by KPC-Kp in neurosurgery intensive care unit(NICU).Methods The clinical data of patients with respiratory tract infection by KPC-Kp in NICU of a level A tertiary hospital from January 2017 to March 2019 were analyzed.The prognostic factors were analyzed by univariate analysis and multivariate Logistic analysis.Results Univariate analysis showed that the age of patient over 70 years old,length of stay in ICU,ventilator use,hemorrhagic stroke,epilepsy,cardiac insufficiency,renal insufficiency,gastrointestinal bleeding,pancreatitis,electrolyte disorder,coagulation dysfunction and use of tegacycline were the related factors of death in KPC-Kp patients with respiratory tract infection in NICU;multivariate Logistic analysis showed that cardiac insufficiency,age over 70 years old and use of tegacycline were independent risk factors of death in KPC-Kp patients with respiratory tract infection in NICU.Conclusion For the elderly patients with cardiac and renal dysfunction,we should use rational drugs,improve the prognosis of patients,control the prevalence of KPC-Kp in hospital,and reduce the KPC-Kp infection and mortality of patients in NICU.