2021 年第 8 期 第 16 卷

血流和尿路感染耐碳青霉烯类肺炎克雷伯菌患者死亡的相关危险因素分析

Analysis of risk factors of death in patients with bloodstream and urinary tract infections with carbapenem-resistant Klebsiella pneumoniae

作者：赵建平1王珊珊2吴忠伟3武芳4

英文作者：Zhao Jianping1 Wang Shanshan2 Wu Zhongwei3 Wu Fang4

单位：1内蒙古自治区人民医院检验科，呼和浩特010010；2扎兰屯市人民医院检验科，内蒙古自治区呼伦贝尔市162650；3呼和浩特市第一医院检验科010030；4内蒙古医科大学附属医院消化科，呼和浩特010050

英文单位：1Department of Laboratory Medicine Inner Mongolia People′s Hospital Hohhot 010010 China; 2Department of Laboratory Medicine People′s Hospital of Zalantun City Inner Mongolia Autonomous Region Hulun Buir 162650 China; 3Department of Laboratory Medicine Hohhot First Hospital Hohhot 010030 China; 4Department of Pharmacy the Affiliated Hospital of Inner Mongolia Medical University Hohhot 010050 China

关键词：耐碳青霉烯类肺炎克雷伯菌；血流感染；尿路感染；死亡；危险因素

英文关键词：Carbapenem-resistantKlebsiellapneumoniae;Bloodstreaminfection;Urinarytractinfection;Death;Riskfactors

• 摘要：

• 目的 分析血流和尿路感染耐碳青霉烯类肺炎克雷伯菌(CRKP)患者死亡的相关危险因素。方法 选取内蒙古自治区人民医院2017年1月至2019年6月血液和尿液标本培养出CRKP的住院患者32例和97例。采用单因素和多因素Logistic回归方法分析血流和尿路感染CRKP患者死亡的相关危险因素。结果 单因素Logistic回归分析显示，深静脉置管、使用抗菌药物（碳青霉烯类、喹诺酮类）和抗真菌药与血流感染CRKP患者死亡相关（均P＜0.05）。多因素Logistic回归分析结果显示，使用抗真菌药是血流感染CRKP患者死亡的独立危险因素（P=0.010）。单因素Logistic回归分析结果显示，男性、年龄≥65岁、入院时急性生理学与慢性健康状况评分系统Ⅱ评分≥15分、广谱抗菌药物使用史、留置尿管、肿瘤史、手术史、糖尿病、高血压病、慢性肾病、使用抗菌药物（碳青霉烯类、喹诺酮类）和抗真菌药与尿路感染CRKP患者死亡相关（均P＜0.05）。多因素Logistic回归分析结果显示，年龄≥65岁、广谱抗菌药物使用史和使用抗真菌药是尿路感染CRKP患者死亡的独立危险因素（比值比=43.868、0.039、103.717，95%置信区间：2.014～955.413、0.004～0.350、12.045～893.074，P=0.016、0.004、＜0.001）。结论 使用抗真菌药是血流感染CRKP患者死亡的独立危险因素，而年龄≥65岁、广谱抗菌药物使用史和使用抗真菌药是尿路感染CRKP患者死亡的独立危险因素。

• Objective To analyze the risk factors of death in patients with bloodstream and urinary tract infections with carbapenem-resistant Klebsiella pneumoniae(CRKP). Methods From January 2017 to June 2019, 32 blood and 97 urine samples of inpatients that had cultured CRKP in Inner Mongolia People′s Hospital were enrolled. Univariate and multivariate Logistic regression analysis was performed on the related risk factors of death in patients with bloodstream and urinary tract infections with CRKP. Results Univariate Logistic regression analysis showed that deep vein catheterization and the use of antimicrobial drugs (carbapenem, quinolones) and antifungal drug were correlated with death of patients with CRKP bloodstream infection (all P＜0.05). Multivariate Logistic regression analysis showed that the use of antifungal drugs was an independent risk factor for death in patients with CRKP bloodstream infection（P=0.010）. Univariate Logistic regression analysis showed that male, age≥65 years, acute physiology and chronic health status scoring system Ⅱ score ≥15 at admission, history of broad-spectrum antibacterial drugs use, indwelling catheter, tumor history, surgery history, diabetes mellitus, hypertension, chronic kidney disease, use of antimicrobial drugs (carbapenem, quinolones) and antifungal drugs were associated with death in patients with CRKP urinary tract infection (all P＜0.05). Multivariate Logistic regression analysis showed that age ≥65 years, history of broad-spectrum antimicrobial use and antifungal drug use were independent risk factors for death in patients with CRKP urinary tract infection（odds ratio=43.868, 0.039, 103.717， 95% confidence interval： 2.014-955.413, 0.004-0.350, 12.045-893.074， P=0.016, 0.004, ＜0.001）. Conclusion  The use of antifungal drugs is an independent risk factor for death in patients with CRKP bloodstream infection, while age≥65 years, history of broad-spectrum antibiotics use and antifungal drugs use are independent risk factors for death in patients with CRKP urinary tract infection.