Risk Factors and Prognosis of Carbapenem-Resistant Klebsiella pneumoniae Infections in Respiratory Intensive Care Unit: A Retrospective Study.
Risk Factors and Prognosis of Carbapenem-Resistant Klebsiella pneumoniae Infections in Respiratory Intensive Care Unit: A Retrospective Study.
复制标题
呼吸重症监护室耐碳青霉烯类肺炎克雷伯菌感染的危险因素和预后：回顾性研究。
DOI：
10.2147/idr.s317233
复制
发表时间：
2021
影响因子：
3.9
通讯作者：
Cai Y
中科院分区：
文献类型：
--
作者：
Zhang H;Wang J;Zhou W;Yang M;Wang R;Yan X;Cai Y
耐碳青霉烯类肺炎克雷伯菌（CRKP）感染已成为一个严重的威胁与高发病率和死亡率。早期识别CRKP感染的危险因素很重要，但这些因素仍有争议。因此，我们旨在确定CRKP感染的风险因素和临床结局。回顾性、单中心研究于2017年至2020年在中国人民解放军总医院呼吸重症监护室进行。感染K.肺炎克雷伯氏菌被纳入并分类为CRKP组和碳青霉烯类敏感性肺炎克雷伯氏菌。根据对碳青霉烯类抗生素的敏感性，对肺炎链球菌（CSKP）进行分组。采用单因素分析和多因素Logistic回归分析方法，对影响脑卒中发生的独立危险因素进行分析。并对两组患者的临床疗效进行评价。本研究共纳入138例符合条件的患者，中位年龄为80.5岁（四分位距：62.0 - 86.3），其中78.3%为男性。在138例患者中，CRKP组有97例患者，另外41例被分配到CSKP组。多因素分析显示，暴露于≥ 3种类型的合并症（OR = 5.465，P = 0.003）、既往住院（OR = 4.279，P = 0.006）、使用喹诺酮类药物（OR = 5.872，P = 0.012）和留置导尿管（OR = 5.035，P = 0.000）是CRKP感染的独立危险因素。CRKP组的住院死亡率为42.1%，高于CSKP组（17.5%，P = 0.006）。暴露于≥ 3种类型的合并症、既往住院、使用喹诺酮类药物和留置导尿管是CRKP感染的独立危险因素，与CSKP感染相比，CRKP感染的死亡率较高。应早期发现高危患者并及时采取控制措施，以防止CRKP感染的发生，从而改善临床结局。
Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections have become a serious threat with high morbidity and mortality. Early identification of risk factors for CRKP infections is important, but these factors are still controversial. Therefore, we aimed to identify the risk factors and clinical outcomes of CRKP infections. The retrospective, single-center study was carried out in the respiratory intensive care unit of the Chinese People’s Liberation Army General Hospital from 2017 to 2020. Patients infected with K. pneumoniae were included and categorized into the CRKP group and carbapenem-sensitive K. pneumoniae (CSKP) group based on the susceptibility to carbapenems. The independent risk factors were investigated by univariate analysis and multivariate logistic regression analysis. The clinical outcomes were also evaluated between the two groups. A total of 138 eligible patients were included in our study, with a median age of 80.5 years (interquartile range: 62.0–86.3), and 78.3% of them were males. Of the 138 patients, there were 97 patients in the CRKP group, and the other 41 were assigned into the CSKP group. Multivariate analysis showed that exposure to ≥three types of comorbidities (OR = 5.465, P = 0.003), previous hospitalization (OR = 4.279, P = 0.006), use of quinolones (OR = 5.872, P = 0.012), and indwelling urinary catheter (OR = 5.035, P = 0.000) were independent risk factors for CRKP infections. The in-hospital mortality rate of the CRKP group was 42.1%, which was higher compared with the CSKP group (17.5%, P = 0.006). Exposure to ≥three types of comorbidities, previous hospitalization, use of quinolones, and indwelling urinary catheter were independent risk factors for CRKP infections, which had higher mortality compared with CSKP infections. Early detection of high-risk patients and timely control measures should be implemented to prevent the emergence of CRKP infections and thereby improve the clinical outcomes.