中国循证医学杂志

中国循证医学杂志

重症患者耐碳氢酶烯肺炎克雷伯菌感染的临床特征及预后分析

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目的 分析安徽医科大学第二附属医院重症医学科住院患者的耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的临床特征及预后。 方法 回顾性收集 2017 年 1 月至 2018 年 4 月安徽医科大学第二附属医院重症医学科 19 例 CRKP 患者的临床资料,并选取同期碳青霉烯敏感的肺炎克雷伯菌(CSKP)感染的 21 名患者为对照组,分析 CRKP 感染的危险因素。 结果 CRKP 患者以下呼吸道为主(89.5%),脓毒症休克发生率比 CSKP 患者更高(χ2 =8.338,P=0.004),联合使用抗菌药物更多(χ2=26.3,P<0.001),住院时间更长(χ2=–2.217,P=0.027),抗菌药物费用占比(χ2=12.855,P=0.005)更高,CRKP 患者 14 天(χ2=4.269,P=0.039)和 28 天存活率(χ2=5.647,P=0.017)明显下降。CRKP 菌株耐药率高,未发现对替加环素耐药的菌株。CRKP 感染的危险因素包括:三代头孢和/或碳氢酶烯类抗生素暴露(χ2 =6.388,P=0.041)、三代头孢暴露时间(U=–2.187,P=0.029)、碳氢酶烯类抗生素暴露时间(U=–2.103,P=0.035)、气管插管(χ2=6.352,P=0.012)、气管切开(χ2=4.821,P=0.028)、SOFA 评分(t=4.505,P<0.001)和 Charlson 合并症指数(t=3.041,P=0.004),其中 SOFA 评分为 CRKP 感染的独立危险因素(P=0.03)。 结论 ICU 内 CRKP 感染直接影响患者病程、生存时间和治疗费用,加强细菌耐药监测、合理运用抗菌药物、保护患者的免疫功能对于 CRKP 感染的防治有重要意义。

Objectives To identify the clinical characteristics and prognosis for CRKP (Carbapenem-resistant Klebsiella pneumonia, CRKP) infection among ICU patients in the Second Affiliated Hospital of Anhui Medical University. Methods We conducted a retrospectively analysis in which 19 patients infected by CRKP with another 21 CSKP (Carbapenem-sensitive Klebsiella pneumoniae, CSKP) infected patients from January 2017 to April 2018. Risk factors for CRKP infection were assessed. Results The lower respiratory tract is the most common site of CRKP infection in our department. CRKP infection was associated with several clinical symptoms, particularly a higher incidence of sepsis shock (χ2=8.338, P=0.004), more application of the combined medicine (χ2=26.3, P<0.001), prolonged hospital stays (χ2=–2.217, P=0.027) and more expenses on antibiotics (χ2=12.855, P=0.005), and the declined survival rates in 14 days (χ2=4.269, P=0.039) and 21 days (χ2 =5.647, P=0.017). The resistance rate of CRKP strains was high, however no resistance to tegafycline was found. The risk factors of CRKP infection included three generations of cephalosporin and/or hydrocarbonase antibiotics exposure (χ2 =6.388, P=0.041), exposure time of three generations of cephalosporin (U=–2.187, P=0.029), exposure time of hydrocarbonase antibiotics (U=–2.103, P=0.035), tracheal intubation (χ2=6.352, P=0.012), tracheotomy (χ2 =4.821, P=0.028), SOFA score (t=4.505, P<0.001) and Charlson comorbidity index (t=3.041, P=0.004). The SOFA score was the only factor independently associated with CRKP bacteremia (P=0.02). Conclusions CRKP infections in ICU directly affect the course of disease, survival time and treatment expenses of patients. Therefore, monitoring bacterial resistance, rational use of antibiotics, and protection of the immune function are of great significance for prevention and treatment of CRKP infection.

关键词: 耐碳氢酶烯肺炎克雷伯菌; 细菌耐药; 临床特征; 危险因素; 预后

Key words: Carbapenem-resistant Klebsiella pneumonia; Bacteria resistance; Clinical characteristics; Risk factor; Prognosis

引用本文: 李惠, 郑瑶, 杨翔, 张频捷, 肖文艳, 杨旻. 重症患者耐碳氢酶烯肺炎克雷伯菌感染的临床特征及预后分析. 中国循证医学杂志, 2019, 19(2): 129-134. doi: 10.7507/1672-2531.201809113 复制

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