产气克雷伯菌血流感染患者的临床特征与预后分析

Clinical features and prognosis analysis on the patients with bloodstream infection caused by Klebsiella aerogenes

目的:探讨产气克雷伯菌血流感染患者的临床特征与预后的影响因素。方法:本研究为单中心回顾性队列研究,纳入2016年12月—2020年12月武汉大学人民医院产气克雷伯菌血流感染患者,分为预后良好组和预后不良组,对比两组患者的临床特征和病原学资料。结果:本研究共纳入28例患者,平均年龄(61.4±19.1)岁,男性16例(57.1%)。24例(85.7%)发病前进行过侵入性操作,8例(32.1%)为多重耐药菌感染。9例(32.1%)需要接受重症监护治疗,6例(21.4%)合并休克,病死率21.4%。单因素分析显示,合并肺部基础疾病、多重耐药菌感染、休克、需要重症监护治疗为导致产气克雷伯菌血流感染患者预后不良的危险因素,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,多重耐药菌感(OR=2.58)、休克(OR=28.00)、需要重症监护治疗(OR=13.33)是导致患者预后不良的独立危险因素(P<0.05)。结论:产气克雷伯菌血流感染患者病情危重,死亡率高,多重耐药菌感染、休克、需要重症监护治疗是导致患者预后不良的独立危险因素。

Objective:To investigate the clinical features and prognostic factors of patients with blood⁃stream infection caused by Klebsiella aerogenes.Methods:This was a retrospective cohort study on patients with bloodstream infections caused by Klebsiella aerogenes in Renmin Hospital of Wuhan Uni⁃versity from December 2016 to October 2020.The patients were divided into the good prognosis group and the poor prognosis group.The clinical characteristics and etiological data of the two groups were compared.Results:A total of 28 patients were included in this study,with an average age of(61.4±19.1)years,and 16 cases(57.1%)were male.24 cases(85.7%)had an invasive operation before onset,8 cases(32.1%)had multidrug⁃resistant bacterial infection,9 cases(32.1%)received intensive care,6 cases(21.4%)complicated with shock,and the mortality was 21.4%.Univariate analysis showed that a combination of basic lung diseases,multidrug⁃resistant bacterial infection,shock,and requirement of intensive care were the risk factors for poor prognosis of patients with bloodstream infection caused by Klebsiella aerogenes(P<0.05).Multivariate logistic regression anal⁃ysis showed that multidrug⁃resistant bacterial infection(OR=2.58),shock(OR=28.00),and re⁃quirement of intensive care(OR=13.33)were independent risk factors for poor prognosis of patients with bloodstream infection caused by Klebsiella aerogenes.Conclusion:Most patients with blood⁃stream infections caused by Klebsiella aerogenes are complicated with basic diseases,and invasive op⁃erations are often carried out before onset.Patients with multidrug⁃resistant bacterial infection,shock,and intensive care treatment are prone to death.