重症监护病房碳青霉烯类耐药与敏感肺炎克雷伯菌感染患者经济损失及预后研究

Economic loss and prognosis of patients with carbapenem-resistant and carbapenem-sensitive Klebsiella pneumoniae infection in intensive care unit

目的研究耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的重症监护患者预后情况,评价CRKP感染经济负担及死亡风险,为制定有针对性的防控策略提供参考。方法选取2017年1月—2019年6月某院重症监护病房(ICU)送检标本中检出肺炎克雷伯菌的患者为研究对象。采用回顾性队列研究方法将患者分为CRKP感染组和碳青霉烯类敏感肺炎克雷伯菌(CSKP)感染组,分析其住院直接费用及死亡情况,并采用Kaplan-Meier分析死亡风险,采用Cox比例风险模型分析死亡风险的影响因素。结果共纳入236例重症监护患者,其中CRKP感染组患者175例,CSKP感染组患者61例。CRKP和CSKP感染组均以下呼吸道感染为主。CRKP感染组患者病死率(28.00%)高于CSKP感染组(13.11%),差异有统计学意义(P<0.05)。CRKP感染组患者的总住院费用比CSKP感染组患者高63648.34元(Z=-3.923,P<0.001),增幅48.76%;其中增幅最多的是抗菌药物费用,增幅达107.78%。CRKP和CSKP感染组重症监护患者30天死亡风险比较,差异有统计学意义(χ2=5.554,P=0.018),但两组患者90天死亡风险比较,差异无统计学意义(χ2=2.603,P=0.107)。与CSKP感染组相比,CRKP感染组增加患者30天死亡风险的影响因素有患者患循环系统疾病、机械通气和年龄。结论CRKP感染增加了重症监护患者的住院费用和死亡风险,抗菌药物更多的使用是住院费用负担加重的主要原因,机械通气是增加重症监护患者死亡风险的主要因素。临床应合理使用抗菌药物,及时评估机械通气必要性,减少耐药菌产生,改善患者预后。

Objective To study the prognosis of patients with carbapenem-resistant Klebsiella pneumoniae(CRKP)infection in intensive care unit(ICU),evaluate the economic burden and death risk of CRKP infection,and provide reference for formulating targeted prevention and control strategies.Methods Patients who were isolated Klebsiella pneumoniae from specimens in ICU of a hospital between January 2017 and June 2019 were selected as the research objects,they were divided into CRKP infection group and carbapenem-sensitive Klebsiella pneumoniae(CSKP)infection group by retrospective cohort study,direct hospitalization expense and mortality were analyzed,Kaplan-Meier was adopted to analyze the risk of death,Cox proportional hazards model was used to analyze the influencing factors for risk of death.Results A total of 236 ICU patients were included in analysis,including 175 in CRKP infection group and 61 in CSKP infection group.Lower respiratory tract infection was the major infection in both CRKP infection group and CSKP infection group.Mortality of patients in CRKP infection group was higher than that of CSKP group(28.00%vs 13.11%,P<0.05).The total hospitalization expense of patients in CRKP infection group was 63648.34 Yuan higher than that of patients in CSKP infection group(Z=-3.923,P<0.001),with an increase of 48.76%;the most significant increase was the expense of antimicrobial agents,which increased by 107.78%.There was significant difference in 30-day death risk between ICU patients in CRKP infection group and CSKP infection group(χ2=5.554,P=0.018),but there was no significant difference in 90-day death risk between two groups of patients(χ2=2.603,P=0.107).Compared with CSKP infection group,risk factors for the increase of 30-day death risk in CRKP infection group were circulatory diseases,mechanical ventilation and age of patients.Conclusion CRKP infection increases hospitalization expense and risk of death in ICU patients.More use of antimicrobial agents is the main cause for the increase of hospitalization expense burden,mechanical ventilation is the main cause for the increase of death risk in ICU patients.Clinical application of antimicrobial agents should be rational,the necessity of mechanical ventilation should be evaluated in time,so as to reduce the emergence of antimicrobial-resistant organisms and improve prognosis of patients.