回顾性分析安徽省某三甲医院耐碳青霉烯类肺炎克雷伯菌感染死亡的危险因素

Retrospective analysis of risk factors for death from carbapenem-resistant Klebsiella pneumoniae infection in a tertiary hospital in Anhui province

目的选取安徽省某三甲医院近三年感染耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumonia,CRKP)病例进行回顾性研究,分析CRKP感染与患者死亡之间存在的相关危险因素。方法收集自2017年6月至2020年5月入住安徽省合肥市第二人民医院广德路院区共303例确诊感染CRKP的患者信息,对所收集资料采用多因素Logistic回归以及单因素卡方检验进行统计学分析。结果在所有与CRKP感染有关的因素中,共13个因素是导致患者死亡的高危因素。根据Logistic回归分析显示,有6个高危因素可构成CRKP患者致死的独立危险因素,分别为:住院治疗时间不少于14天(P=0.025)、使用有创呼吸机(P<0.001)、合并冠心病(P=0.037)、入住重症监护室(P=0.034)、血管内导管(P=0.047)、住院期间发生过休克(P=0.027)。结论诸多因素可导致CRKP感染患者死亡,在临床工作中应该尽量避免不必要住院期限的延长及侵入性操作,对高危患者应进行预防和早期干预,从源头上减少CRKP的感染;对于已发生感染的患者应合理使用抗微生物药物,以降低感染CRKP患者的病死率。

Objective A retrospective study was performed on the cases of carbapenem-resistant Klebsiella pneumonia(CRKP)infection in a tertiary hospital in Anhui Province in the past three years,and the related risk factors between CRKP infection and patient death were analyzed.Methods From June 2017 to May 2020,a total of 303 patients with confirmed CRKP infection who were admitted to the Guangde Road Campus of the Second People′s Hospital of Hefei City,Anhui Province were collected.The collected data were statistically analyzed by multivariate Logistic regression and univariate chi-square test.Result Among all the factors associated with CRKP infection,a total of 13 factors were high-risk factors for the death of patients.Logistic regression analysis showed that six high-risk factors could constitute independent risk factors for death in patients with CRKP,including hospitalization time of not less than 14 days(P=0.025),use of an invasive ventilator(P<0.001),complicated with coronary heart disease(P=0.037),admission to intensive care unit(P=0.034),an intravascular catheter(P=0.047),and shock during hospitalization(P=0.027).Conclusion Many factors can lead to the death of patients with CRKP infection.In clinical work,the extension of unnecessary hospitalization periods and invasive operations should be avoided as much as possible.Prevention and early intervention should be carried out for high-risk patients to reduce CRKP infection from the source.Antimicrobials should be used rationally for patients who have developed infections to reduce the mortality rate of patients infected with CRKP.