老年患者碳青霉烯类耐药肺炎克雷伯菌血流感染危险因素及预后分析

Risk factors and prognosis of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in elderly patients

目的探讨老年患者碳青霉烯类耐药肺炎克雷伯菌(CRKP)血流感染的危险因素、死亡危险因素以及抗感染治疗。方法收集广州市某院2018—2022年连续5年因CRKP血流感染的70例患者的人口学资料及临床资料,根据患者的年龄分为年轻组和老年组,分组分析老年患者CRKP血流感染危险因素。将老年患者CRKP血流感染30 d预后分为存活组和死亡组,分析CRKP血流感染患者的死亡相关危险因素以及治疗方案。结果住院到感染时间延长、有呼吸衰竭、消化系统疾病、泌尿道感染等基础病是≥65岁老年患者CRKP血流感染危险因素。55例老年CRKP血流感染患者30 d死亡率为54.5%,住院到感染时间延长、降钙素原水平增高、进行机械通气、合并感染性休克均是老年患者CRKP血流感染死亡的危险因素,住院到感染时间延长(OR=1.071,P=0.032)、合并感染性休克(OR=7.101,P=0.014)是老年患者CRKP血流感染死亡的独立危险因素。44例患者30 d死亡率为50.0%(22/44),30 d死亡率在单药组治疗与联合用药治疗组方案差异无统计学意义;抗感染治疗方案中,以碳青霉烯类药物(28例)为基础的治疗是最常见的用药方案,有7例亚胺培南联合替加环素的治疗方案,30 d病死率为85.7%(6/7),有3例亚胺培南联合米诺环素的治疗方案,3例患者30 d结局均存活。结论老年患者CRKP血流感染后死亡率高,感染后常规剂量替加环素治疗可增加患者死亡风险;使用碳青霉烯类药物联合米诺环素对降低CRKP血流感染患者死亡率有积极意义。

Objective To investigate the risk factors for carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection,risk factors for mortality,and anti-infective therapy in elderly patients.Methods The demographic and clinical data of 70 patients with CRKP bloodstream infection were collected in a hospital for 5 consecutive years from 2018 to 2022.The patients were assigned to young group(<65 years old)or elderly group(≥65 years old)to analyze the risk factors of CRKP bloodstream infections in the elderly patients.The elderly patients with CRKP bloodstream infection were compared between the 30-day deaths and survivors to analyze the risk factors and antimicrobial treatment regimens for 30-day mortality of elderly patients.Results Longer time from admission to infection and underlying diseases such as respiratory failure,digestive system disease,and urinary tract infection were risk factors for CRKP bloodstream infection in elderly patients.The 30-day mortality rate was 54.5%in the 55 elderly patients with CRKP bloodstream infection.Longer time from admission to infection,elevated levels of procalcitonin,indwelling mechanical ventilation,and septic shock were risk factors for 30-day death from CRKP bloodstream infection in the elderly patients.Longer time from admission to infection(OR=1.071,P=0.032)and septic shock(OR=7.101,P=0.014)were independent risk factors for 30-day death from CRKP bloodstream infection in the elderly patients.The correlation between antimicrobial therapy and 30-day mortality was analyzed in 44 elderly patients,the overall 30-day mortality rate of which was 50.0%(22/44).Antimicrobial monotherapy and combination therapies did not show statistically significant difference in the 30-day mortality.Carbapenem-based therapies(28 cases)was the most common regimen in this study.Imipenem combined with tigecycline(7 cases)was associated with a 30-day mortality rate of 85.7%(6/7).Imipenem combined with minocycline(3 cases)was associated with a 30-day survival of 100%.Conclusions CRKP bloodstream infection is associated with a high mortality rate in elderly patients.Standard-dose tigecycline treatment may increase the risk of death in elderly patients.Carbapenems combined with minocycline may have a positive effect on 30-day outcome of patients with CRKP bloodstream infection.