医院获得性肺炎克雷伯菌血流感染临床特征及预后影响因素

Clinical characteristics and prognostic risk factors of hospital acquired Klebsiella pneumoniae bloodstream infection

目的探讨医院获得性肺炎克雷伯菌血流感染(nKP BSI)的临床特征及预后影响因素,为治疗nKP BSI提供依据。方法对2014年5月至2019年4月南京医科大学第二附属医院收治的nKP BSI住院患者临床资料(年龄、性别、住院科室、合并疾病、感染原发灶、有创治疗措施、临床最终结局及药敏试验结果等)进行回顾性分析。采用Logistic回归分析影响患者28 d预后的独立危险因素。结果90例nKP BSI患者中以男性居多(64/90、71.1%),年龄中位数为67.5(56.75,82.25)岁,来自本院16个诊疗单元,最常见于ICU(16/90、17.8%),其次为消化内科(12/90、13.3%)和肾内科(11/90、12.2%)。入组nKP BSI患者并发症中最常见为肺部感染(52/90、57.8%)。患者常见原发感染灶为下呼吸道感染(33/90、36.7%)、胆道感染(17/90、18.9%)和导管相关性感染(12/90、13.3%)。患者侵入性诊疗操作以尿管插入(38/90、42.2%)为主,其次为中心静脉置管(35/90、38.9%)。入组患者共分离90株分离株,其中碳青霉烯类耐药肺炎克雷伯菌(CRKP)17例(18.9%),CRKP患者28 d病死率高达52.9%(9/17)。90例nKP BSI患者28 d病死率为31.1%(28/90)。多因素Logistic回归分析显示Pitt菌血症评分(PBS)≥3分(OR=5.614、95%CI:1.298~24.577、P=0.021),Charlson并发症指数(CCI)≥6分(OR=6.862、95%CI:1.480~31.824、P=0.014)及呼吸衰竭(OR=18.534、95%CI:1.557~220.628、P=0.021)均为影响nKp BSI患者28 d预后的独立危险因素。结论nKp BSI多发于老年男性,下呼吸道及胆道感染为其常见的原发疾病,尿管插入与中心静脉置管为该病发生的重要医源性因素;该病患者PBS≥3分、CCI≥6分及合并呼吸衰竭为影响预后的重要危险因素,此类患者应予高度重视。

Objective To investigate the clinical characteristics and prognostic risk factors ofnosocomial Klebsiella pneumonia bloodstream infection (nKP BSI) and provide evidence for clinicaltreatment of nKP BSI. Methods The clinical data including age, gender, inpatient department, complicateddiseases, primary infection, invasive treatment, clinical outcome and result of drug sensitivity analysis ofhospitalized patients with nKP BSI admitted to the Second Affiliated Hospital of Nanjing Medical Universityfrom May 2014 to April 2019 were analyzed, retrospectively. Logistic regression analysis was used to analyzeindependent risk factors for 28-day prognosis of patients. Results The majority of patients with nKP BSIwere male (64/90, 71.1%), with a median age of 67.5 (56.75, 82.25) years old. The 90 patients were from16 clinical departments of the hospital, mostly in ICU (16/90, 17.8%), followed by gastroenterology (12/90,13.3%) and nephrology (11/90, 12.2%). nKP BSI was often complicated with multiple diseases, and the mostcommon of which was pulmonary infection (52/90, 57.8%). The most common primary infection site was the respiratory tract (33/90, 36.7%), followed by biliary tract (17/90, 18.9%) and catheter-related (12/90, 13.3%).The most common invasive treatment during hospitalization was urinary catheter (38/90, 42.2%), followed bycentral venous catheter (35/90, 38.9%). Among the 90 isolates, 17 strains were carbapenem resistant Klebsiellapneumoniae (CRKP) and the 28-day mortality rate was 52.9% (9/17). The 28-day mortality rate of nKp BSIwas 31.1% (28/90). Multivariate Logistic regression analysis showed that Pitt bacteriaemia score (PBS) ≥ 3(OR = 5.614, 95%CI: 1.298-24.577, P = 0.021), Charlson comorbidity index (CCI) ≥ 6 (OR = 6.862, 95%CI:1.480-31.824, P = 0.014) and respiratory failure (OR = 18.534, 95%CI: 1.557-220.628, P = 0.021) were allindependent risk factors for 28-day prognosis of patients with nKP BSI. Conclusions nKP BSI occurs mainly inelderly male patients. Lower respiratory tract and biliary tract infections were common primary diseases. Urinarycatheter and central venous catheterization were important iatrogenic factors for nKP BSI. PBS ≥ 3, CCI ≥ 6and respiratory failure were important risk factors of prognosis. High attention should be paid to such patients.