耐碳青霉烯类肺炎克雷伯菌血流感染流行病学及影响因素分析

Epidemiology and influencing factors analysis of bloodstream infection of carbapenem-resistant Klebsiella pneumoniae

目的调查肺炎克雷伯菌(KP)血流感染中耐碳青霉烯类肺炎克雷伯菌(CRKP)血流感染的比例,分析CRKP血流感染的影响因素。方法回顾性分析2013—2022年联勤保障部队第908医院收治的KP血流感染患者的临床和微生物学资料,采用logistic回归分析CRKP血流感染发生的影响因素。结果687株KP血流感染分离株中,CRKP占比为38.86%(267/687)。KP血流感染的CRKP比例从2013年的0.0%升高至2022年的47.8%。logistic回归分析显示,呼吸系统疾病、血液系统疾病、胰腺炎、既往ICU住院史、发生血流感染前住院时间>30 d、既往有创机械通气、既往侵入性尿路导管、发生血流感染前30 d内使用碳青霉烯类药物是发生CRKP血流感染的危险因素。结论KP中高死亡率的CRKP血流感染发生率快速上升需要引起临床重视,重点关注CRKP血流感染的危险因素,采取并落实预防和控制措施。

Objective To investigate the proportion of carbapenem-resistant Klebsiella pneumoniae bloodstream infection(CRKP-BSI)among KP-BSI cases,and to analyze the risk factors and prognosis associated with CRKP-BSI.Methods A retrospective analysis of clinical and microbiological data was conducted on KP-BSI patients admitted to the 908 Hospitals of The Chinese PLA Logistics Support Force from 2013 to 2022.Logistic regression was utilized to analyze risk factors for hospitalacquired carbapenem Klebsiella pneumoniae bacteremia.Results Among the 687 isolates of KP bloodstream infection,CRKP accounted for 38.86%(267/687).The proportion of CRKP among KP bloodstream infections increased from 0.0%in 2013 to 47.8%in 2022.Logistic regression analysis indicated that respiratory disease,hematological disease,pancreatitis,previous ICU,hospitalization for more than 30 days before bloodstream infection,history of invasive mechanical ventilation,history of invasive urinary catheterization,and use of carbapenems within 30 days before bloodstream infection were identified as risk factors for CRKP bloodstream infection.Conclusion The rapid increase in the incidence of CRKP-BSI with high mortality among KP patients requires clinical attention.It is imperative to focus on identifying the risk factors of CRKP-BSI,and implementing prevention and control measures.