耐碳青霉烯类肺炎克雷伯菌感染及预后相关因素分析
|
摘要
目的:研究碳青霉烯类耐药肺炎克雷伯菌(CRKP)感染患者的临床特征、感染及预后相关危险因素。方法:采用回顾性研究,对天津医科大学总医院2016年12月-2017年10月感染耐碳青霉烯类肺炎克雷伯菌住院患者的临床资料进行分析,按1:1设计病例-病例对照研究,CRKP感染组71例,匹配碳青霉烯类敏感肺炎克雷伯菌(CSKP)感染组71例作为对照,感染及预后相关危险因素采用单因素及多因素Logistic回归分析。结果:单因素分析显示,患有肝胆疾病、糖尿病,7 d内接受机械通气,近3月内使用碳青霉烯类药物、β-内酰胺酶抑制剂复合制剂、替加环素以及联合使用抗生素均为CRKP的危险因素(P<0.05或P<0.01);年龄、患有肝胆疾病、肾脏疾病、神经系统疾病、消化系统疾病,7 d内接受动脉穿刺、留置尿管≥3 d,入住ICU天数、分离菌株前住院天数以及总住院天数为CRKP感染患者死亡的危险因素(P<0.05或P<0.01)。多因素Logistic回归分析显示,患有糖尿病,机械通气和联合使用抗生素为CRKP感染的独立危险因素;患有肾脏疾病和神经系统疾病为CRKP感染患者死亡的独立危险因素。结论:临床应合理使用抗菌药物,减少侵袭性操作,改善患者免疫功能,降低CRKP的感染及改善预后。
Objective: To study the clinical characteristics, infection and prognosis risk factors of patients with Carbapenem-resistant Klebsiella pneumoniae(CRKP)infection. Methods: The clinical data ofhospitalized patients with CRKP infection of General Hospital of Tianjin Medical University during December 2016 and October 2017 were retrospectively analyzed, and we designed a 1:1 case-control study, including 71 patients with CRKP bacteremia as experiment group and 71 patient with Carbapenem-sensitive Klebsiella pneumoniae(CSKP)bacteremia as control group. Related risk factors for infection and prognosis were analyzed by univariate and multivariate Logistic regression. Results: Univariate analysis showed that hepatobiliary disease, diabetes mellitus, mechanical ventilationwithin 7 days, use of carbapenems, β-lactamase inhibitor compound, tigecycline and combined antibiotics within 3 months were risk factors for CRKP infection(P<0.05 or P< 0.01); while older age, hepatobiliary disease, renal disease and neurological disease, digestive system disease, arteriopuncturewithin 7 days, indwelling catheter ≥3 days, duration of ICU stay, hospital stay prior to CRKP isolation and length of hospital stay were risk factors for death of patients with CRKP(P < 0.05 or P< 0.01). Multivariate Logistic regression analysis showed that diabetes mellitus, me chanical ventilation and combined antibioticswere independent risk factors for CRKP infection;renal disease and neurological disease were independent risk factors for death from CRKP infection. Conclusion: Rational use of antibiotics, strict control of invasive procedures and improved immune function may reduce the infection of CRKP and improve the prognosis.
Objective: To study the clinical characteristics, infection and prognosis risk factors of patients with Carbapenem-resistant Klebsiella pneumoniae(CRKP)infection. Methods: The clinical data ofhospitalized patients with CRKP infection of General Hospital of Tianjin Medical University during December 2016 and October 2017 were retrospectively analyzed, and we designed a 1:1 case-control study, including 71 patients with CRKP bacteremia as experiment group and 71 patient with Carbapenem-sensitive Klebsiella pneumoniae(CSKP)bacteremia as control group. Related risk factors for infection and prognosis were analyzed by univariate and multivariate Logistic regression. Results: Univariate analysis showed that hepatobiliary disease, diabetes mellitus, mechanical ventilationwithin 7 days, use of carbapenems, β-lactamase inhibitor compound, tigecycline and combined antibiotics within 3 months were risk factors for CRKP infection(P<0.05 or P< 0.01); while older age, hepatobiliary disease, renal disease and neurological disease, digestive system disease, arteriopuncturewithin 7 days, indwelling catheter ≥3 days, duration of ICU stay, hospital stay prior to CRKP isolation and length of hospital stay were risk factors for death of patients with CRKP(P < 0.05 or P< 0.01). Multivariate Logistic regression analysis showed that diabetes mellitus, me chanical ventilation and combined antibioticswere independent risk factors for CRKP infection;renal disease and neurological disease were independent risk factors for death from CRKP infection. Conclusion: Rational use of antibiotics, strict control of invasive procedures and improved immune function may reduce the infection of CRKP and improve the prognosis.
引文
[1] Marquez P, Terashita D, Dassey D, et al. Population-based incidence of carbapenem-resistant Klebsiella pneumoniae along the continuum of care, Los Angeles County[J]. Infect Contr Hosp Epidemiol, 2013, 34(2):144
[2]胡付品,郭燕,朱德妹,等. 2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志, 2017, 17(5):481
[3] Schwaber M J, Klarfeld-Lidji S, Navon-Venezia S, et al. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality[J]. Antimicrob Agents Chemother, 2008, 52(3):1028
[4] Clinical and Laboratory Standards Istitute. Performance standards for antimicrobial susceptibility testing[S]. Twenty-First informational supplement,2012,M100~S22
[5] Wang Z, Qin R R, Huang L, et al. Risk Factors for Carbapenemresistant Klebsiella pneumoniae Infection and Mortality of Klebsiella pneumoniae Infection[J]. Chin Med J, 2018, 131(1):56
[6]孔海芳,胡志东,李静,等.耐碳青霉烯类鲍曼不动杆菌感染危险因素分析:一项病例-病例-对照研究[J].中华临床感染病杂志,2016, 9(3):224
[7]叶相如,胡必杰,周春妹,等.耐碳青霉烯类肺炎克雷伯菌感染与定植患者预后相关因素分析[J].中华医院感染学杂志, 2015(11):2489
[8]毛文炜,周华,杨青,等.耐亚胺培南肺炎克雷伯菌腹腔感染患者的临床特征及预后[J].中国微生态学杂志, 2017, 29(2):166
[9] Munozprice L S, Poirel L, Bonomo R A, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases[J]. Lancet Inf Dis, 2013, 13(9):785
[10] Borer A, Saidel-Odes L, Eskira S, et al. Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenemresistant K pneumoniae[J]. Amer J Infect Contr, 2012, 40(5):421
[11]刘敏,徐萍,杨婉花,等.碳青霉烯类耐药的肺炎克雷伯菌感染患者的治疗效果及预后因素评价[C].中国药学会青年药学科研成果交流会,2016
[12] Girmenia C, Rossolini G M, Piciocchi A, et al. Infections by carbapenem-resistant Klebsiella pneumoniae in SCT recipients:a nationwide retrospective survey from Italy[J]. Bone Marrow Transplant,2015, 50(2):282
[13] Jiao Y, Qin Y, Liu J, et al. Risk factors for carbapenem-resistant infection/colonization and predictors of mortality:a retrospective study[J]. Pathog Glob Health, 2015, 109(2):68
[14]钟秀君,汤杰,顾克菊,等.耐碳青霉烯类肺炎克雷伯菌的耐药性及预后相关因素分析[J].中华医院感染学杂志, 2017, 27(6):1201
[15]聂佳.耐碳青霉烯的肺炎克雷伯菌感染1例[J].中华肺部疾病杂志(电子版), 2016(1):101
[2]胡付品,郭燕,朱德妹,等. 2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志, 2017, 17(5):481
[3] Schwaber M J, Klarfeld-Lidji S, Navon-Venezia S, et al. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality[J]. Antimicrob Agents Chemother, 2008, 52(3):1028
[4] Clinical and Laboratory Standards Istitute. Performance standards for antimicrobial susceptibility testing[S]. Twenty-First informational supplement,2012,M100~S22
[5] Wang Z, Qin R R, Huang L, et al. Risk Factors for Carbapenemresistant Klebsiella pneumoniae Infection and Mortality of Klebsiella pneumoniae Infection[J]. Chin Med J, 2018, 131(1):56
[6]孔海芳,胡志东,李静,等.耐碳青霉烯类鲍曼不动杆菌感染危险因素分析:一项病例-病例-对照研究[J].中华临床感染病杂志,2016, 9(3):224
[7]叶相如,胡必杰,周春妹,等.耐碳青霉烯类肺炎克雷伯菌感染与定植患者预后相关因素分析[J].中华医院感染学杂志, 2015(11):2489
[8]毛文炜,周华,杨青,等.耐亚胺培南肺炎克雷伯菌腹腔感染患者的临床特征及预后[J].中国微生态学杂志, 2017, 29(2):166
[9] Munozprice L S, Poirel L, Bonomo R A, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases[J]. Lancet Inf Dis, 2013, 13(9):785
[10] Borer A, Saidel-Odes L, Eskira S, et al. Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenemresistant K pneumoniae[J]. Amer J Infect Contr, 2012, 40(5):421
[11]刘敏,徐萍,杨婉花,等.碳青霉烯类耐药的肺炎克雷伯菌感染患者的治疗效果及预后因素评价[C].中国药学会青年药学科研成果交流会,2016
[12] Girmenia C, Rossolini G M, Piciocchi A, et al. Infections by carbapenem-resistant Klebsiella pneumoniae in SCT recipients:a nationwide retrospective survey from Italy[J]. Bone Marrow Transplant,2015, 50(2):282
[13] Jiao Y, Qin Y, Liu J, et al. Risk factors for carbapenem-resistant infection/colonization and predictors of mortality:a retrospective study[J]. Pathog Glob Health, 2015, 109(2):68
[14]钟秀君,汤杰,顾克菊,等.耐碳青霉烯类肺炎克雷伯菌的耐药性及预后相关因素分析[J].中华医院感染学杂志, 2017, 27(6):1201
[15]聂佳.耐碳青霉烯的肺炎克雷伯菌感染1例[J].中华肺部疾病杂志(电子版), 2016(1):101