摘要
目的探讨耐碳青霉烯类肺炎克雷伯菌(CRKP)血流感染患者的死亡危险因素和不同抗菌治疗方案对预后的影响。方法回顾性分析四川省内某三甲医院2016年1月至2019年12月CRKP血流感染患者的病历资料,根据30 d预后情况分为存活组和死亡组,进行死亡危险因素分析,并比较联合用药组和单药组的差异。结果共有48例CRKP血流感染者,病例来源最多的科室是ICU(n=27,56.3%),其次是血液内科(n=10,20.8%)。36例纳入死亡危险因素分析,30 d病死率为52.8%(19/36),合并多器官功能障碍综合征是30 d死亡的独立危险因素(P<0.05)。单药组(n=7)和联合用药组(n=29)的差异无统计学意义(P>0.05)。4例采用了延长输注碳青霉烯类的患者存活率100.0%,其中3例采用了替加环素联合碳青霉烯类。结论CRKP血流感染患者有着较高的病死率,合并多器官功能障碍综合征是CRKP血流感染患者30 d死亡的独立危险因素。延长输注碳青霉烯类药物可能有较好治疗效果。
Objective To explore risk factors for mortality and antimicrobial therapy of bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods In the retrospective study,patients with bloodstream infections(BSIs)caused by CRKP,who were hospitalized in a Tier III hospital in Sichuan from January 2016 to December 2019,were assigned to survival or death groups according to the 30-day prognosis.The risk factors of death were analyzed,and the differences between the combination group and the single drug group were compared.Results There were 48 patients with BSIs caused by CRKP.ICU was the largest source of the cases(n=27,56.3%),followed by Hematology department(n=10,20.8%).A total of 36 nonduplicate CRKP blood isolates were enrolled in this study with a 30-day mortality rate of 52.8%(19/36).In a logistic regression analysis,30-day mortality was independently associated with multiple organ dysfunction syndrome(P<0.05).The 30-day mortality rate of the patients(n=29)treated with antimicrobial combination therapy was similar to those(n=7)receiving monotherapy(P>0.05).Four patients who received prolonged-infusion regimen of a carbapenem survived,and 3 of them received combination therapy of tigecycline and carbapenem.Conclusion CRKP BSIs are associated with high mortality.A 30-day mortality rate was independently associated with multiple organ dysfunction syndrome.To improve survival rate,prolonged-infusion regimen of carbapenems may be more effective.
作者
曹培
杨勇
张志勇
CAO Pei;YANG Yong;ZHANG Zhiyong(West China School of Medicine,Sichuan University,Chengdu 610041,China;Department of Pharmacy,Hospital Affiliated to University of Electronic Science and Technology,Sichuan Provincial People’s Hospital,Chengdu 610072,China;Department of Pharmacy,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《医药导报》
CAS
北大核心
2021年第8期1048-1052,共5页
Herald of Medicine
关键词
耐碳青霉烯类肺炎克雷伯菌
血流感染
死亡危险因素
Carbapenem-resistant Klebsiella pneumoniae
Bloodstream infection
Risk factors for mortality
