108例肺炎克雷伯菌血流感染的临床特征和预后分析

Clinical characteristics and prognostic factors of 108 cases of Klebsiella pneumoniae bloodstream infection

目的:探讨重庆医科大学附属永川医院肺炎克雷伯菌血流感染的临床特征和影响预后的危险因素。方法:回顾性分析2019年1月至2021年7月108例肺炎克雷伯菌血流感染患者的临床资料及实验室数据,根据患者的临床转归分为好转组与预后不良组,通过logistic回归分析预后不良的危险因素,并行ROC曲线分析。结果:肺炎克雷伯菌血流感染的患者科室主要分布在ICU(19.4%)、感染科(13.9%)、肝胆外科(10.3%)、血液内科(8.4%);86.1%的患者存在基础疾病,主要为糖尿病(38.9%)、高血压(25.0%)、恶性实体肿瘤(14.8%)。108株引起血流感染的肺炎克雷伯菌与1 631株非血流感染的肺炎克雷伯菌药敏结果比较显示,对厄他培南的耐药率分别为8.3%、14.8%。根据转归不同,年龄、住院时间、入住ICU及贫血差异有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄(OR=1.044,95%CI=0.002~0.083,P=0.038)、住院时间(OR=0.936,95%CI=-0.110~-0.023,P=0.003)、入住ICU(OR=8.794,95%CI=0.855~3.493,P=0.001)及贫血(OR=5.638,95%CI=0.684~2.775,P=0.001)为肺炎克雷伯菌血流感染预后不良的独立危险因素。PCT升高(OR=0.094,95%CI=0.021~0.166,P=0.011)是肺炎克雷伯菌血流感染死亡的危险因素。结论:老年人、贫血、入住ICU是肺炎克雷伯菌血流感染患者预后不良的危险因素,尽早进行病原学检查及恰当的经验性治疗可以改善预后。

Objective:To explore the clinical characteristics of Klebsiella pneumoniae bloodstream infection in Yongchuan Hospital of Chongqing Medical University and the risk factors affecting the prognosis.Methods:The clinical and laboratory data of 108 patients with Klebsiella pneumoniae bloodstream infection who were admitted to hospital from January 2019 to July 2021 were retrospectively analyzed. The patients were divided into clinical improvement group and poor prognosis group according to clinical outcomes. Logistic regression and receiver operator characteristic(ROC) curve were used to analyze the predictors of poor outcome.Results:Patients with Klebsiella pneumoniae bloodstream infection were mainly distributed in ICU(19.4%),department of infectious diseases(13.9%),department of hepatobiliary surgery(10.3%),department of hematology(8.4%)and so on;86.1% patients suffered from underlying diseases,including diabetes mellitus(38.9%),hypertension(25.0%),and malignant solid tumor(14.8%). The resistance rates of 108strains of bloodstream infection-caused Klebsiella pneumoniae and 1 631 strains of non-bloodstream infection-caused Klebsiella pneumoniae were 8.3% and 14.8%,respectively. There were significant differences in age,hospital stay,ICU admission and anemia between poor prognosis group and clinical improvement group(P < 0.05). The multivariate logistic regression analysis showed that age(OR=1.044,95%CI=0.002-0.083,P=0.038),length of hospital stay(OR=0.936,95%CI=-0.110--0.023,P=0.003),admission to ICU(OR=8.794,95%CI=0.855-3.493,P=0.001),and anemia(OR=5.638,95%CI=0.684-2.775,P=0.001)were independent risk factors for the poor prognosis of Klebsiella pneumoniae bloodstream infection. Furthermore,elevated PCT(OR=0.094,95%CI=0.021-0.166,P=0.011) was shown to be a risk factor for death from Klebsiella pneumoniae bloodstream infection.Conclusion:The elderly,anemia and ICUstay are risk factors for poor prognosis in patients with Klebsiella pneumoniae bloodstream infection. Early etiological examinationand appropriate empirical treatment can improve the prognosis.