摘要
目的分析碳青霉烯类耐药肺炎克雷伯菌(CRKP)血流感染的危险因素,探讨急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、序贯性器官功能衰竭(SOFA)评分对患者28 d死亡的预测价值。方法回顾性分析2017年1月-2019年6月东方市人民医院ICU住院的96例肺炎克雷伯菌(KP)所致血流感染患者的临床资料,依据感染情况分为碳青霉烯类敏感肺炎克雷伯菌(CSKP)组和CRKP组,依据患者预后情况分为存活组和死亡组。采用单因素及多因素Logistic回归分析筛选CRKP血流感染的危险因素,分析KP患者28 d死亡的危险因素;采用受试者工作特征曲线(ROC)评价APACHEⅡ评分、SOFA评分对患者28 d死亡的预测价值。结果CRKP患者55例(57.3%),CSKP患者41例(42.7%)。感染前入住ICU(OR=2.489)、行机械通气(OR=1.315)、使用抗生素(OR=1.171)、使用碳青霉烯类药物(OR=1.818)均是CRKP血流感染的独立危险因素(P<0.05)。感染时APACHEⅡ评分(OR=1.239)、SOFA评分(OR=1.473)及感染性休克(OR=1.799)是KP血流感染患者28 d死亡的独立危险因素(P<0.05)。ROC曲线分析显示,APACHEⅡ评分、SOFA评分预测KP血流感染28 d死亡的曲线下面积分别为0.794(95%CI:0.704~0.884,P=0.003)、0.829(95%CI:0.749~0.909,P=0.005)。结论CRKP血流感染患者病死率较高,感染前入住ICU、行机械通气、使用抗生素、使用碳青霉烯类药物是其独立危险因素,感染时APACHEⅡ评分、SOFA评分可作为KP患者28 d死亡的预测因子。
Objective To investigate the risk factors for bloodstream infection caused by carbapenem resistant Klebsiella pneumoniae(CRKP),and explore the value of acute physiology and chronic health examinationⅡ(APACHEⅡ)score and the sequential organ failure assessment(SOFA)score in predicting 28-day death.Methods The clinical data of 96 patients with Klebsiella pneumoniae(KP)caused bloodstream infection who were hospitalized in ICU of the hospital from January 2017 to June 2019 were retrospectively analyzed.According to the infection status,the patients were divided into carbapenem-sensitive Klebsiella pneumonia(CSKP)group and CRKP group.According to the prognosis,the patients were divided into survival group and death group.Univariate analysis and multivariate Logistic regression analysis were performed to screen the risk factors for CRKP bloodstream infection,and the risk factors for 28-day death of KP patients were investigated.The value of APACHEⅡscore and SOFA score in predicting 28-day death were evaluated with the receiver operating characteristic(ROC)curve.Results There were 55 patients(57.3%)with CRKP bloodstream infection and 41 patients(42.7%)with CSKP.ICU stay before infection(OR=2.489),undergoing mechanical ventilation(OR=1.315),using antibiotics(OR=1.171),and using carbapenems(OR=1.818)were all independent risk factors for CRKP bloodstream infection(P<0.05).The APACHEⅡscore with infection(OR=1.239),SOFA score(OR=1.473)and septic shock(OR=1.799)were independent risk factors for 28-day death of patients with KP bloodstream infection(P<0.05).ROC curve analysis showed that the areas under the curves of APACHEⅡscore and SOFA score for predicting 28-day death of patients with KP bloodstream infection were 0.794(95%CI:0.704-0.884,P=0.003),0.829(95%CI:0.749-0.909,P=0.005),respectively.Conclusion The mortality rate of patients with CRKP bloodstream infection was high.Stay in ICU before infection,undergoing mechanical ventilation,using antibiotics and carbapenems were the independent risk factors.The APACHEⅡscore and SOFA score with infection could be used as predictors of the 28-day death of patients with KP.
作者
陈积静
丁秀秀
吉雪芳
孙丽萍
CHEN Ji-jing;DING Xiu-xiu;JI Xue-fang;SUN Li-ping(Second Internal Medicine Dongfang People’s Hospital,Dongfang,Hainan 572600;Department of Respiration Hainan General Hospital,Haikou,Hainan 570311,China)
出处
《热带医学杂志》
CAS
2021年第4期490-494,共5页
Journal of Tropical Medicine
基金
海南自然科学基金(20168341)。
关键词
肺炎克雷伯菌
碳青霉烯类耐药
血流感染
急性生理学与慢性健康状况评分
Klebsiella pneumoniae
Carbapenem resistance
Bloodstream infection
Acute physiology and chronic health examination score
作者简介
陈积静(1985-),女,本科,主治医师,主要从事临床呼吸内科工作,E-mail:c15595763398@163.com。
