多重耐药肺炎克雷伯杆菌所致医院获得性感染的预后影响因素分析

Risk factors of prognosis of nosocomial infection caused by multi-drug resistant Klebsiella pneumonia

目的探讨影响多重耐药肺炎克雷伯杆菌预后的相关因素。方法抽取2017年5月至2019年9月新泰市第二人民医院收治的多重耐药肺炎克雷伯杆菌感染患者85例,按照预后情况将其分为死亡组29例和存活组56例,对两组患者的临床特征、血清学指标进行分析,并将相关因素纳入Logistic多元回归分析模型中,分析影响此类患者预后的关键因素。结果存活组与死亡组患者的通气方式、导管留置形式、肌酐水平比较差异未见统计学意义(P>0.05);存活组胆碱酯酶水平[(4175.5±335.9)g/L]高于死亡组[(2517.6±295.8)g/L],其降钙素原[PCT,(0.18±0.05)ng/ml]、C反应蛋白[CRP,(42.4±5.7)mg/L]、白细胞计数[(58.3±12.5)×10^9/L]低于死亡组[(2.05±0.26)ng/ml、(58.9±4.6)mg/L、(14.2±1.6)×10^9/L],差异有统计学意义(P<0.05)。胆碱酯酶是影响多重耐药肺炎克雷伯杆菌院内获得性感染患者预后的独立危险因素(P<0.05)。结论白细胞计数、PCT、CRP、胆碱酯酶均是影响多重耐药肺炎克雷伯杆菌医院获得性感染患者预后的重要因素,其中血清胆碱酯酶水平是影响此类患者预后的独立危险因素,其水平与患者死亡风险呈负相关。

Objective To investigate the factors affecting the prognosis of nosocomial infection caused by multi-drug resistant Klebsiella pneumonia.Methods A total of 85 patients with nosocomial infection caused by multi-drug resistant Klebsiella pneumonia treated in Xintai Second People’s Hospital from May 2017 to September 2019 were selected.And they were divided into death group(29 cases)and survival group(56 cases)according to their prognoses.The clinical characteristics and serological indexes of the two groups were analyzed,and relevant factors were put into the Logistic multiple regression analysis model to analyze the key factors affecting the prognoses of such patients.Results There were no significant differences between the survival group and the death group in ventilation mode,catheter indwelling method,and creatinine level(P>0.05).The level of cholinesterase in survival group was(4175.5±335.9)g/L,higher than the(2517.6±295.8)g/L in the death group(P<0.05).In the survival group,the procalcitonin(PCT)level was(0.18±0.05)ng/ml,C-reactive protein(CRP)level was(42.4±5.7)mg/L,white blood cell count was(58.3±12.5)×10^9/L,lower than the(2.05±0.26)ng/ml,(58.9±4.6)mg/L,(14.2±1.6)×10^9/L in the death group(P<0.05).Cholinesterase was an independent risk factor affecting the prognoses of patients with nosocomial infection caused by multi-drug resistant Klebsiella pneumoniae(P<0.05).Conclusions White blood cell count,PCT,CRP and cholinesterase are important factors affecting the prognoses of patients with nosocomial infection caused by multi-drug resistant Klebsiella pneumonia.Chlinesterase is an independent risk factor of prognosis negatively correlated with the risk of death.