内科理论与实践

内科理论与实践 ›› 2022, Vol. 17 ›› Issue (01): 73-77.doi: 10.16138/j.1673-6087.2022.01.014

• 论著 • 上一篇    下一篇

血流感染耐碳青霉烯类肺炎克雷伯菌患者的死亡危险因素分析

卞秀娟1, 包志瑶2(), 陈虹2, 承璐潇1, 石宝平1   

  1. 1.上海市宝山区仁和医院呼吸与危重症医学科,上海 200431
    2.上海交通大学医学院附属瑞金医院呼吸与危重症医学科,上海 200025
  • 收稿日期:2021-11-04 出版日期:2022-02-28 发布日期:2022-07-25
  • 通讯作者: 包志瑶 E-mail:baojiangu0514@126.com
  • 基金资助:
    上海市宝山区仁和医院中青年优秀人才培养计划(BSRHYQ-2020-02)

Analysis of risk factors for mortality in patients with bloodstream infection of Carbapenem-resistant Klebsiella pneumonia

BIAN Xiujuan1, BAO Zhiyao2(), CHEN Hong2, CHENG Luxiao1, SHI Baoping1   

  1. 1. Department of Respiratory and Critical Care Medicine, Renhe Hospital, Baoshan District, Shanghai 200431, China
    2. Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2021-11-04 Online:2022-02-28 Published:2022-07-25
  • Contact: BAO Zhiyao E-mail:baojiangu0514@126.com

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摘要：

目的： 分析耐碳青霉烯类肺炎克雷伯菌（Carbapenem-resistant Klebsiella pneumonia, CRKP）血流感染患者的临床特征和死亡危险因素。方法： 回顾性分析上海交通大学医学院附属瑞金医院2017年1月至2019年6月CRKP血流感染的电子病历,根据感染后30 d预后情况分为生存组和死亡组,分析其临床特征和死亡危险因素。结果： 共纳入74例CRKP血流感染患者,总死亡率为55.4%。30 d内死亡的独立危险因素是急性生理学和慢性健康状况评价Ⅱ（acute physiology and chronic health evaluationⅡ,APACHEⅡ） 评分≥16.5分[优势比（odds ratio,OR）=1.118, 95%置信区间（confidence interval,CI）: 1.012~1.236, P=0.029]、感染性休克（OR=12.52, 95%CI: 3.002~52.227, P=0.001）。结论： CRKP血流感染患者的死亡率较高,APACHE Ⅱ评分越高,死亡风险越大,评分每增加1分,死亡风险增加11.8%。出现感染性休克的死亡风险是无感染性休克患者的12.52倍。

关键词: 血流感染, 耐碳青霉烯类肺炎克雷伯菌, 死亡危险因素, 急性生理学和慢性健康状况评价

Abstract:

Objective: To evaluate the clinical characteristics and risk factors for mortality of bloodstream infections of Carbapenem-resistant Klebsiella pneumonia(CRKP). Methods The electronic medical records of the patients with CRKP bloodstream infection in Ruijin hospital in Shanghai from January 2017 to June 2019 were reviewed and analyzed retrospectively. The patients were divided into survival group and death group according to the clinical endpoint of 30 d after infection, and their clinical characteristics and risk factors for mortality were analyzed. Results A total of 74 patients with CRKP bloodstream infection were enrolled, and the mortality rate was 55.4%. The independent risk factors for mortality within 30 d were acute physiology and chronic health evaluation (APACHE) Ⅱscore≥16.5 [odds ratio (OR)=1.118, 95% confidence interval(CI): 1.012-1.236, P=0.029], and septic shock(OR=1.52, 95% CI: 3.002-52.227, P=0.001). Conclusions The patients with CRKP bloodstream infection have a high mortality rate. The higher APACHEⅡ score is, the greater risk of mortality will be. For each additional point in the score, the risk of death increased 11.8%. The risk of death in the patients with septic shock is 12.52 times higher than that in higher than without septic shock.

Key words: Bloodstream infection, Carbapenem-resistant Klebsiella pneumoniae, Risk factors for mortality, Acute physiology and chronic health evaluation

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