| 苏贝,刘丽萍,李益明.耐碳青霉烯类肺炎克雷伯菌血流感染及预后的危险因素研究[J].安徽医药,2026,30(10):2085-2090. |
| 耐碳青霉烯类肺炎克雷伯菌血流感染及预后的危险因素研究 |
| Study on risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection and prognosis |
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| DOI：10.3969/j.issn.1009-6469.2026.10.034 |
| 中文关键词: 肺炎克雷伯菌 抗药性，细菌 耐碳青霉烯类肺炎克雷伯菌 血流感染 危险因素 预后 |
| 英文关键词: Klebsiella pneumoniae Drug resistance,bacterial Carbapenem resistant Klebsiella pneumoniae Bloodstream infec-tion Risk factors Prognosis |
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| 摘要点击次数: 95 |
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| 中文摘要: |
| 目的探讨耐碳青霉烯类肺炎克雷伯菌( CRKP)致血流感染( BSI)及预后的危险因素。方法回顾性研究。选取 2022年 3月至 2025年 3月于安徽中科庚玖医院诊治的 150例肺炎克雷伯菌( KP)致 BSI病人作为研究对象，根据是否 CR分为 CRKP组和碳青霉烯类敏感肺炎克雷伯菌( CSKP)组，并根据 28 d病死率将 CRKP-BSI病人分为生存组( n=38)和死亡组( n=34)；对比基线资料，采用 logistic回归分析影响 CRKP-BSI发生及 28 d病死率的危险因素。结果 CRKP组的年龄 ≥65岁、入院时白蛋白 < 30 g/L、中心静脉导管留置 ≥7 d、导尿管留置 ≥7 d、感染前 1个月内使用免疫抑制剂、碳青霉烯类、三代头孢菌素占比率分别为 62.50%(45/72)、 54.17%(39/72)、 48.61%(35/72)、 38.89%(28/72)、 31.94%(23/72)、 52.78%(38/72)、 31.94%(23/72)均显著高于 CSKP组［ 44.87%(35/78)、 33.33%(26/78)、 26.92%(21/78)、 21.79%(17/78)、 17.95%(14/78)、24.36%(19/78)、19.23%(1，5/78)］，差异有统计学意义( P<0.05)。单因素分析显示，年龄 ≥65岁占比、入院时白蛋白 <30 g/L、感染前中心静脉导管留置 ≥7 d和导尿管留置 ≥7 d、感染前 1个月内使用免疫抑制剂、碳青霉烯类、三代头孢菌素是影响 CRKP-BSI的危险因素( P<0.05)。多因素 logistic回归分析显示，入院时白蛋白 <30 g/L、感染前中心静脉导管留置 ≥7 d和导尿管留置 ≥7 d、感染前 1个月内使用碳青霉烯类抗菌药物是影响 CRKP-BSI发生的独立危险因素( P<0.05)。 72例 CRKP-BSI病人的 28 d病死率为 47.22%(34/72)。死亡组入院时急性生理学和慢性健康状况评价 Ⅱ(APACHEⅡ)评分、感染前进行机械通气、感染性休克占比率分别为( 15.44±2.70)分、79.41%(27/34)、 61.76%(21/34)，均显著高于生存组［( 12.00±2.90)分、 15.79%(6/38)、 13.16%(5/38)］，差异有统计学意义( P<0.05)；单因素分析显示，入院时 APACHEⅡ评分、感染前进行机械通气、感染性休克是影响 CRKP-BSI病人 28 d病死率的危险因素( P<0.05)。多因素 logistic回归分析显示， APACHEⅡ评分升高、感染前进行机械通气、感染性休克是影响 CRKP-BSI病人 28 d病死率的独立危险因素( P<0.05)。结论入院时低白蛋白血症( <30 g/L)、中心静脉导管留置 ≥7 d、导尿管留置 ≥7 d及感染前 1个月内碳青霉烯类暴露是 CRKP-BSI发生的独立危险因素；而疾病严重程度( APACHEⅡ评分升高)、感染前进行机械通气支持和感染性休克是 CRKP-BSI病人 28 d病死率的独立危险因素，依据这些危险因素，有利于识别高危死亡人群，为临床干预提供决策依据。 |
| 英文摘要: |
| Objective To explore the risk factors for bloodstream infection (BSI) and prognosis caused by carbapenem-resistant Kleb-siella pneumoniae (CRKP).Methods Retrospective study. A total of 150 patients with Klebsiella pneumoniae (KP) -BSI treated at Anhui Zhongke Gengjiu Hospital from March 2022 to March 2025 were selected as the study subjects. They were divided into CRKPgroup and carbapenem sensitive Klebsiella pneumoniae (CSKP) group based on carbapenem resistance, and CRKP-BSI patients were divided into survival group (n = 38) and death group (n = 34) based on 28 day mortality rate. Compared with the baseline data, Logisticregression analysis was used to analyze the risk factors influencing the occurrence of CRKP-BSI and the 28-day mortality rate.Results The The proportions of patients in the CRKP group aged ≥ 65 years, with albumin < 30 g/L at admission, central venous catheter place-ment for ≥ 7 days, urinary catheter placement for ≥ 7 days, and use of immunosuppressants, carbapenems, and third-generation cepha-losporins within 1 month before infection were 62.50% (45/72), 54.17% (39/72), 48.61% (35/72), 38.89% (28/72), 31.94% (23/72),52.78% (38/72), 31.94% (23/72), which were significantly higher than those in the CSKP group [44.87% (35/78), 33.33% (26/78),26.92% (21/78), 21.79% (17/78), 17.95% (14/78), 24.36% (19/78), 19.23% (15/78)], the differences were statistically significant (P< 0.05). Univariate analysis showed that the proportion of age ≥ 65 years old, albumin < 30 g/L at admission, indwelling of central venous catheter ≥ 7 days and urinary catheter ≥ 7 days before infection, use of immunosuppressants, carbapenems, and third-generation cepha-losporins within one month before infection were risk factors affecting CRKP-BSI (P<0.05). Multivariate Logistic regression analysisshowed that albumin < 30 g/L at admission, indwelling of central venous catheter ≥ 7 days and urinary catheter ≥ 7 days before infec-tion, and use of carbapenem antibacterial drugs within one month before infection were independent risk factors affecting the occur-rence of CRKP-BSI (P<0.05). The 28-day fatality rate of 72 patients with CRKP-BSI was 47.22% (34/72). The acute physiology andchronic health evaluation Ⅱ (APACHE Ⅱ) score at admission, the proportion of patients receiving mechanical ventilation before infec-tion, and the proportion of patients with septic shock in the death group were (15.44±2.70) points, 79.41% (27/34), 61.76 (21/34),which were significantly higher than those in the survival group [(12.00±2.90) points, 15.79 (6/38), 13.16 (5/38)], the differences werestatistically significant (P<0.05). Univariate analysis showed that APACHE Ⅱ score at admission, mechanical ventilation before infec-tion and septic shock were the risk factors for 28 d mortality in CRKP-BSI patients (P<0.05). Multivariate Logistic regression analysisshowed that increased APACHE Ⅱ score, mechanical ventilation before infection and septic shock were independent risk factors for 28d mortality in patients with CRKP-BSI (P<0.05).Conclusion Hypoalbuminemia (< 30 g/L) at admission, indwelling of central venouscatheter for ≥ 7 days, indwelling of urinary catheter for ≥ 7 days, and exposure to carbapenems within one month before infection are in-dependent risk factors for the occurrence of CRKP-BSI. The severity of the disease (elevated APACHE Ⅱ score), mechanical ventila-tion support before infection, and septic shock are independent risk factors for the 28-day mortality rate of patients with CRKP-BSI. Based on these risk factors, it is conducive to identifying high-risk mortality populations and providing a decision-making basis for clini-cal intervention. |
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