耐碳青霉烯类肺炎克雷伯菌血流感染危险因素

Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection

目的探讨耐碳青霉烯肺炎克雷伯菌(CRKP)血流感染的危险因素,为临床诊治提供科学依据,提高患者预后。方法收集2019年3月-2022年2月医院收治的CRKP血流感染患者86例为CRKP组,同期碳青霉烯类敏感肺炎克雷伯菌(CSKP)血流感染患者180例为CSKP组,收集两组患者临床资料,单因素和多因素Logistic回归分析CRKP血流感染的危险因素。结果CRKP与CSKP菌株对除了呋喃妥因以外其他常用抗菌药物的耐药率比较均有统计学差异(P<0.05),其中耐药率较高的抗菌药物有头孢哌酮/舒巴坦、氨苄西林、头孢唑林、哌拉西林/他唑巴坦等;CSKP组患者28 d的存活率显著高于CRKP组(P<0.05);单因素分析结果显示,CRKP血流感染的危险因素有低蛋白血症、使用抗菌药物、使用激素、留置中心静脉导管、留置侵入性器械、入住ICU、应用抗菌药物种类多于3种(均P<0.05);多因素Logistic回归分析显示留置中心静脉导管、应用抗菌药物3种及以上和使用碳青霉烯类抗菌药物均为CRKP血流感染的独立危险因素(均P<0.05)。结论留置中心静脉导管、应用抗菌药物多于3种、使用碳青霉烯类抗菌药物、入住ICU、低蛋白血症是CRKP血流感染的危险因素。

OBJECTIVE To explore the risk factors for carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection so as to provide scientific basis for clinical diagnosis and treatment and improve prognosis.METHODS A total of 86 patients with CRKP bloodstream infection who were treated in the hospital from Mar 2019 to Feb 2022 were assigned as the CRKP group,meanwhile,180 patients who had carbapenem-sensitive K.pneumoniae(CSKP)bloodstream infection were chosen as the CSKP group.The clinical data were collected from the two groups of patients,univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the CRKP bloodstream infection.RESULTS There were significant differences in the drug resistance rates to the commonly used antibiotics except for nitrofurantoin between the CRKP strains and the CSKP strains(P<0.05),the drug resistance rates to cefoperazone-sulbactam,ampicillin,cefazolin and piperacillin-tazobactam were relatively high.The 28-day mortality rate of the CSKP group was remarkably higher than that of the CRKP group(P<0.05).The result of univariate analysis showed that the risk factors for the CRKP bloodstream infection included hypoproteinemia,use of antibiotics,use of hormones,central venous catheter indwelling,invasive instrument indwelling,ICU stay and use of no less than 3 types of antibiotics(all P<0.05).Multivariate logistic regression analysis indicated that the central venous catheter indwelling,use of no less than 3 types of antibiotics and use of carbapenems were the independent risk factors for the CRKP bloodstream infection(all P<0.05).CONCLUSION The central venous catheter indwelling,use of no less than 3 types of antibiotics,use of carbapenems,ICU stay and hypoproteinemia are the risk factors for the CRKP bloodstream infection.