摘要
分析患者碳青霉烯类耐药肺炎克雷伯菌(CRKP)感染和死亡的相关因素。采用病例对照研究方法,以三二〇一医院2019年1月至2021年12月CRKP感染患者作为病例组,按1∶1的比例选取同一时间段内碳青霉烯类敏感肺炎克雷伯菌(CSKP)感染患者作为对照组。对研究对象随访30 d,根据是否死亡分别将2组患者分为存活组和死亡组,比较CRKP病例组和CSKP对照组的30 d病死率。采用logistic回归模型分析感染CRKP以及CRKP感染后死亡的相关因素。本研究共纳入CRKP病例组和CSKP对照组各59例。CRKP感染和CSKP感染患者30 d病死率分别为30.5%(18/59)和5.1%(3/59),差异具有统计学意义( χ^(2)=13.034, P<0.001)。感染KP前3个月内手术( OR=17.285, P=0.001),感染KP前3个月内使用碳青霉烯类药物( OR=11.235, P=0.002),抗菌药物使用种类>3种( OR=7.993, P=0.016),以及感染KP前患者白蛋白<30 g/L( OR=10.463, P=0.002),性别( OR=0.078, P<0.001)及糖尿病( OR=0.076, P=0.011)为CRKP感染的相关因素。患者年龄校正Charlson合并症指数评分较高( OR=1.522, P=0.024)和感染KP前3个月内患者使用碳青霉烯类药物( OR=4.902, P=0.029)为CRKP感染患者死亡的相关因素。综上,医务人员应谨慎实施侵入性手术,严格把控抗生素的使用,尽早对高危患者予以针对性防护和治疗。
To analyze the factors associated with infection and death of carbapenem-resistant Klebsiella pneumoniae(CRKP)in patients.Using a case-control study method,patients with CRKP infection from January 2019 to December 2021 in the 3201 Hospital were selected as the case group,and patients with carbapenem-susceptible Klebsiella pneumoniae(CSKP)infection in the same period were selected as the control group in a ratio of 1∶1.The study subjects were followed up for 30 days.The two groups of patients were categorized into survival and death groups based on whether they died or not,respectively,and the 30-day morbidity and mortality rates of the CRKP case group and the CSKP control group were compared.The logistic regression model was used to analyze the factors associated with CRKP infection and death after CRKP infection.This study included 59 cases in the CRKP case group and 59 in the CSKP control group.The 30-day mortality rate of CRKP-infected patients and CSKP-infected patients were 30.5%(18/59)and 5.1%(3/59),with statistically significant differences(P<0.001).Surgery within three months prior to KP infection(OR=17.285,P=0.001),use of carbapenems within three months prior to KP infection(OR=11.235,P=0.002),use of more than three types of antibiotics(OR=7.993,P=0.016),albumin<30 g/L in patients prior to KP infection(OR=10.463,P=0.002),sex(OR=0.078,P<0.001),and diabetes(OR=0.076,P=0.011)were associated factors of CRKP infection.Higher age-corrected Charlson Comorbidity Index scores of patients(OR=1.522,P=0.024)and use of carbapenems by the patients with in the first three months prior to the KP infection(OR=4.902,P=0.029)were associated factors for the deaths of patients with CRKP.In conclusion,medical personnel should be cautious in performing invasive procedures,strictly control the use of antibiotics,and provide targeted protection and treatment for high-risk patients as soon as possible.
作者
王晓
辜依海
张微
蒋琰
邓明惠
侯轩
周梦蓉
王辉
李晓波
Wang Xiao;Gu Yihai;Zhang Wei;Jiang Yan;Deng Minghui;Hou Xuan;Zhou Mengrong;Wang Hui;Li Xiaobo(College of Medical Technology,Shaanxi University of Chinese Medicine,Xianyang 712046,China;Department of Microbiology and Immunology,3201 Hospital,Hanzhong 723000,China;Department of Infectious Diseases,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2024年第4期545-551,共7页
Chinese Journal of Preventive Medicine
基金
科技基础资源调查专项(2019FY101200)。
