老年脓毒症患者感染耐碳青霉烯类肺炎克雷伯菌危险因素及预后分析

Risk factors and prognosis of carbapenem resistant klebsiella pneumoniae infection in elderly patients with sepsis

目的分析重症监护室(ICU)老年脓毒症患者耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的危险因素及预后。方法选取125例肺炎克雷伯菌阳性老年脓毒症患者,根据是否碳青霉烯类耐药,将其分为耐药组和非耐药组,统计分析2组患者的一般临床资料、标本来源构成、单因素及多因素危险因素及预后。结果2组患者性别、年龄及感染指标差异无统计学意义(P>0.05);2组患者主要标本来源均为痰液及肺泡灌洗液;2组使用碳青霉烯类药物时长≥3 d、中心静脉导管留置天数和感染前30 d内抗生素使用,这3个单因素分析差异有统计学意义(P<0.05);多因素logistic回归分析显示,以上3个危险因素也是预测CRKP感染的独立危险因素;耐药组患者的预后差、28 d病死率高,差异有统计学意义(P<0.05)。结论控制碳青霉烯类抗生素使用,缩短中心静脉导管留置时间,可降低CRKP感染的发生,从而降低老年脓毒症患者病死率,改善预后。

ObjectiveTo analyze the risk factors and prognosis of carbapenem resistant klebsiella pneumoniae(CRKP)infection in elderly patients with sepsis in intensive care unit.Methods 125 elderly patients with klebsiella pneumoniae positive sepsis were divided into non-drug resistant group and drug resistant group according to whether they were resistant to carbapenem.The general clinical data,sample source composition,univariate and multivariate risk factors and prognosis of the two groups were statistically analyzed.Result There was no significant difference in sex,age and infection index between the two groups(P>0.05).Sputum/alveolar lavage fluid was the main source in both groups.There were significant differences between the two groups in the use of carbapenems≥3d,the days of indwelling central venous catheter and the use of antibiotics within 30 days before infection(P<0.05).Multivariate logistic regression analysis showed that the above three risk factors were also independent risk factors for predicting CRKP infection.The prognosis of patients in the drug resistant group was poor and 28 day mortality were significantly different(P<0.05).Conclusion Controlling the use of carbapenem antibiotics and reducing the central venous indwelling time can reduce the incidence of CRKP,thus reducing the mortality of elderly sepsis patients and improving the prognosis.