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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

25卷

期数:

2019年03期

页码:

271-274,284

栏目:

临床医学

出版日期:

2019-05-20

文章信息/Info

Title:

Related risk factors for infection and prognosis of Carbapenem-resistant Klebsiella pneumoniae

文章编号:

1006-8147(2019)03-0271-05

作者:

唐洪影; 李 静; 宋缘缘; 田 彬; 胡志东

（天津医科大学总医院医学检验科，天津300052）

Author(s):

TANG Hong-ying;  LI Jing;  SONG Yuan-yuan;  TIAN Bin;  HU Zhi-dong

（Department of Clinical Laboratory, General Hospital, Tianjin Medical University, Tianjin 300052, China)

关键词:

碳青霉烯类; 肺炎克雷伯菌; 预后; 危险因素

Keywords:

Carbapenem;  Klebsiella pneumonia;  prognosis;  risk factors

分类号:

R446.5

DOI:

-

文献标志码:

A

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。

Abstract:

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, mechanical 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.

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　YU Qian,HU Zhi-dong,LI Jing,et al.Effect of Tigecycline on Klebsiella pneumoniae and Acinetobacter baumanaii by susecptibility testing in vitro[J].Journal of Tianjin Medical University,2015,21(03):510.
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备注/Memo

备注/Memo:

作者简介 唐洪影（1993-），女，硕士在读，研究方向：临床检验诊断；通信作者：胡志东， E-mail: huzhidong27@163.com。

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更新日期/Last Update: 2019-07-03