耐碳青霉烯类肺炎克雷伯菌血流感染的临床特征及转归研究

Clinical characteristics and outcomes of carbapenem-resistant Klebsiella pneumoniae blood stream infections

目的 探讨耐碳青霉烯类肺炎克雷伯菌(CRKP)血流感染患者的临床特征、死亡率及相关危险因素。方法 回顾性收集空军军医大学西京医院2017年1月至2021年12月住院患者中罹患CRKP血流感染者的临床资料,分析其临床特征及转归等相关临床指标。结果 共纳入101例CRKP血流感染患者,其中男性77例(76.2%),中位年龄为52(42~64)岁,病死率为42.6%。消化内科为最常见的检出科室(35例,34.7%),重症急性胰腺炎为最常见的入院诊断(22例,21.8%)。多因素分析结果提示患者死亡的独立危险因素包括Pitt菌血症评分(PBS)>4分(OR=3.118,95%CI:1.163~8.364,P=0.024)、血小板减少症(OR=8.442,95%CI:2.958~24.097,P<0.001)及留置胃管(OR=4.281,95%CI:1.349~13.590,P=0.014)。结论 CRKP血流感染患者临床病死率极高,PBS高、血小板减少症、留置胃管等是患者死亡的独立危险因素,早期诊断、精准判断病情及纠正死亡危险因素是改善患者预后的关键举措。

Objective To explore the clinical characteristics,mortality rate,and related risk factors in patients with carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infections.Methods Clinical data of inpatients with CRKP bloodstream infections in Xijing Hospital,Air Force Medical University from January 2017 to December 2021 were retrospectively collected,and clinical characteristics,outcomes and other related clinical indicators were analyzed.Results A total of 101 patients with CRKP bloodstream infections were enrolled,including 77 males(76.2%),with a median age of 52(42-64)years and a mortality rate of 42.6%.The most commonly detected department was Department of Gastroenterology(35 cases,34.7%).Severe acute pancreatitis was the most common admission diagnosis(22 cases,21.8%).Multivariate analysis suggested that the independent risk factors for mortality were Pitt Bacteremia Score(PBS)>4(OR=3.118,95%CI:1.163-8.364,P=0.024),thrombocytopenia(OR=8.442,95%CI:2.958-24.097,P<0.001),and indwelling gastric tube(OR=4.281,95%CI:1.349-13.590,P=0.014).Conclusion The patients with CRKP bloodstream infections are associated with a extremely high mortality rate.High PBS,thrombocytopenia,and indwelling gastric tube are independent risk factors for mortality.Therefore,early diagnosis and accurate judgement of patients condition and correction of risk factors for mortality are key measures to improve the outcomes of patients.