手术患者耐碳青霉烯类肺炎克雷伯菌血流感染预后不良的危险因素分析

Risk factors for poor outcome of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in patients undergoing surgery

目的 分析手术患者发生耐碳青霉烯类肺炎克雷伯菌(CRKP)血流感染的临床特征及预后不良的危险因素,为临床早期诊断及感染控制提供依据。方法 回顾性分析2017—2020年南京医科大学第一附属医院183例CRKP血流感染患者临床资料及实验室检查,根据血流感染发生前是否有手术史分为手术组(115例)和非手术组(68例),分析手术组患者治疗28 d后的预后影响因素。结果 183例CRKP血流感染患者中62.8%存在手术史,手术组患者在引流管留置和住院时间≥28 d比例均高于非手术组。入住ICU和感染性休克是影响手术组患者预后的独立危险因素。结论 CRKP血流感染患者中手术组人数高于非手术组,入住ICU和感染性休克可显著增加手术患者CRKP血流感染死亡风险,临床医师应积极给予预防和及时诊治措施。

Objective To analyze the clinical characteristics and the risk factors for poor outcome of carbapenem-resistant Klebsiella pneumoniae(CRKP) bloodstream infection in patients undergoing surgery for achieving better diagnosis and treatment.Methods A retrospective analysis were conducted on CRKP bloodstream infection in patients from January 2017 to December 2020in the First Affiliated Hospital of Nanjing Medical University to analyze the clinical characteristics and prognostic factors. Patients were assigned to surgical or non-surgical group according to whether the patient received a surgical operation before the occurrence of bloodstream infection. The patients undergoing surgery were divided into death or survivor group according to the outcome after 28-day treatment. Results Overall, 183 patients were identified with CRKP bloodstream infection, and 62.8%(115/183) of the patients received surgical treatment. The proportions of patients with drainage tube or hospital stay ≥28 days were higher in surgical group compared with non-surgical group. ICU admission and septic shock were independent risk factors for poor outcome of patients in surgical group. Conclusions CRKP bloodstream infection was more prevalenct in surgical patients than in non-surgical patients.ICU admission and septic shock may significantly increase the risk of death from CRKP bloodstream infection in surgical patients.Clinicians should be aware of the risk and provide preventive and timely diagnosis and treatment measures.