肺炎克雷伯菌肺炎的临床特征及危险因素

Clinical features and risk factors of Klebsiella pneumoniae

目的回顾性分析肺炎克雷伯菌肺炎的临床特征及危险因素,以指导临床早期识别和有效治疗。方法选取2021年1月至2022年12月本院呼吸与危重症医学科收治的117例肺炎克雷伯菌肺炎患者作为观察对象,根据耐药性差别分为碳青霉烯类耐药肺炎克雷伯组37例和碳青霉烯类敏感肺炎克雷伯组80例,比较两组一般情况、标本来源情况、临床表现、实验室指标、胸部CT特征且研究碳青霉烯类耐药肺炎克雷伯组的危险因素。采用SPSS26.0统计软件进行数据分析。结果碳青霉烯类耐药肺炎克雷伯组年龄、住院天数、ICU住院天数均高于碳青霉烯类敏感肺炎克雷伯组,碳青霉烯类耐药肺炎克雷伯组发热比例高于碳青霉烯类敏感肺炎克雷伯组,而肌酐水平低于碳青霉烯类敏感肺炎克雷伯组;与碳青霉烯类敏感肺炎克雷伯组胸部CT相比,碳青霉烯类耐药肺炎克雷伯组多表现为胸腔积液,较多表现为左上肺叶累及(P<0.05)。Logistic回归分析显示碳青霉烯类耐药肺炎克雷伯菌组感染的危险因素有:年龄≥65岁、使用有创呼吸机(P<0.05)。结论碳青霉烯类耐药肺炎克雷伯组年龄、住院天数、ICU住院天数均高于碳青霉烯类敏感肺炎克雷伯组,常伴有发热,影像学多表现为胸腔积液,左上肺累及较多,年龄≥65岁、使用有创呼吸机是碳青霉烯类耐药肺炎克雷伯感染的独立危险因素。

Objective The clinical characteristics of Klebsiella pneumoniae infection and risk factors were analyzed to guide early clinical prevention and effective treatment.Methods From one hundred and seventeen cases of Klebsiella pneumoniae treated in the Second Affiliated Hospital of Respiratory and Critical Care Medicine of Anhui Medical University between January 2021 and December 2022,the group was divided into thirty-seven cases of carbapenem resistant pneumonia and eighty cases of carbapenem-susceptible pneumonia to compare the general conditions,specimen source,clinical presentation,clinical index,laboratory index,chest CT characteristics and the risk factors of carbapenem resistant pneumonia infection-Data analysis was performed using the SPSS 26.0 statistical software.Results Age,length of stay,and ICU days in carbapenem-resistant pneumonia Kleber group were higher than in the Carbapenem-susceptible pneumonia group.Fever,and wet rales in carbapenem-resistant pneumonia group were higher than in the carbapenem-susceptible pneumonia group,and creatinine level was lower than carbapenem-susceptible Klebsiella pneumoniae group.Compared with the carbapenem-susceptible pneumonia chest CT,the carbapenem-resistant pneumonia group had a pleural effusion with left upper lung lobe involvement(P<0.05).Logistic Regression analysis showed that the risk factors for the carbapenem resistant pneumonia were:age≥65 years old,use of invasive ventilator(P<0.05).Conclusion Carbapenem-resistant Klebsiella pneumoniae group age,hospital days,ICU hospitalization days are higher than carbapenem-susceptible Klebsiella pneumoniae group,often accompanied by fever and auscultation wet rale,imaging more as pleural effusion,left upper lung involvement,age≥65 years old,the use of the invasive ventilator is an independent risk factor for carbapenem-resistant Klebsiella pneumoniae infection.