产碳青霉烯酶肺炎克雷伯菌感染患者死亡因素分析
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摘要
目的探讨产碳青霉烯酶肺炎克雷伯菌感染引起患者死亡临床影响因素。方法选取2016年8月-2017年10月医院诊治产碳青霉烯酶肺炎克雷伯菌感染患者182例临床资料行回顾性分析,根据患者治疗30天结局分为死亡组和存活组,收集两组患者一般临床资料及可疑影响因素,采用单因素和多因素Logistic回归分析引起患者死亡临床影响因素。结果单因素分析得出,年龄、合并糖尿病、合并慢阻肺、合并恶性肿瘤、感染部位、APACHEⅡ评分、机械通气、留置导尿管、重大手术、抗菌药物治疗方案在死亡组和存活组患者中比较有统计学意义(P<0.05)。多因素分析得出,年龄、感染部位、APACHEⅡ评分、抗菌药物治疗方案为影响产碳青霉烯酶肺炎克雷伯菌感染患者死亡影响因素。结论影响产碳青霉烯酶肺炎克雷伯菌感染患者死亡影响因素较多,临床中针对相关影响因素实施预防、干预对提高疗效,降低死亡率有重要意义。
OBJECTIVE To explore the influencing factors for death of the patients with carbapenemase-producing Klebsiella pneumoniae infection. METHODS A total of 182 patients with carbapenemase-producing K.pneumoniae infection who were treated in the hospital from Aug 2016 to Oct 2017 were enrolled in the study and divided into the death group and the survival group according to the 30-day treatment outcomes, the clinical data of the patients were retrospectively analyzed, the baseline data were collected from the two groups of patients, the suspected influencing factors were analyzed, and univariate analysis and multivariate logistic regression analysis were performed for the clinical influencing factors for death of the patients. RESULTS The univariate analysis showed that there were significant differences in the age, complication with diabetes mellitus, complication with chronic obstructive pulmonary disease, complication with malignant tumors, infection sites, APACHEⅡ score, mechanical ventilation, urinary catheter indwelling, major surgery and antibiotic treatment regimens between the death group and the survival group(P<0.05). The multivariate analysis indicated that the age, infection sites, APACHEⅡ score and antibiotic treatment regimens were the influencing factors for death of the patients with carbapenemase-producing K.pneumoniae infection. CONCLUSION There are a variety of influencing factors for death of the patients with carbapenemase-producing K.pneumoniae infection. It is of great significance to take prevention interventions according to the influencing factors so as to improve the curative effect and reduce the mortality rate.
OBJECTIVE To explore the influencing factors for death of the patients with carbapenemase-producing Klebsiella pneumoniae infection. METHODS A total of 182 patients with carbapenemase-producing K.pneumoniae infection who were treated in the hospital from Aug 2016 to Oct 2017 were enrolled in the study and divided into the death group and the survival group according to the 30-day treatment outcomes, the clinical data of the patients were retrospectively analyzed, the baseline data were collected from the two groups of patients, the suspected influencing factors were analyzed, and univariate analysis and multivariate logistic regression analysis were performed for the clinical influencing factors for death of the patients. RESULTS The univariate analysis showed that there were significant differences in the age, complication with diabetes mellitus, complication with chronic obstructive pulmonary disease, complication with malignant tumors, infection sites, APACHEⅡ score, mechanical ventilation, urinary catheter indwelling, major surgery and antibiotic treatment regimens between the death group and the survival group(P<0.05). The multivariate analysis indicated that the age, infection sites, APACHEⅡ score and antibiotic treatment regimens were the influencing factors for death of the patients with carbapenemase-producing K.pneumoniae infection. CONCLUSION There are a variety of influencing factors for death of the patients with carbapenemase-producing K.pneumoniae infection. It is of great significance to take prevention interventions according to the influencing factors so as to improve the curative effect and reduce the mortality rate.
引文
[1] 马永驰,潘亚萍,佘婷婷,等.产KPC肺炎克雷伯菌检测方法构建与耐药机制[J].安徽医科大学学报,2017,52(8):1173-1178.
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[10] 陈绍淳(综述),张娟(审校).产碳青霉烯酶的肺炎克雷伯菌耐药机制及流行病学研究进展[J].国际检验医学杂志,2016,37(23):3328-3330.
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[12] Codo AC,Saraiva AC,Dos Santos LL,et al.Inhibition of inflammasome activation by a clinical strain of Klebsiella pneumoniae impairs efferocytosis and leads to bacterial dissemination[J].Cell Death Dis,2018,9(12):1182.
[13] 黄伟丽,周杰,李奇峰,等.我院ICU脑干出血患者医院感染病原菌分布及耐药性分析[J].中国药房,2017,28(2):182-185.
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[15] Pan DT,Wang XD,Shi HY,et al.Dynamic flux balance analysis for microbial conversion of glycerol into 1,3-propanediol by Klebsiella pneumoniae[J].Bioprocess Biosyst Eng,2018,41(12):1793-1805.
[16] Bueno MG,Iovine RO,Torres LN,et al.Pneumonia and bacteremia in a golden-headed lion tamarin (Leontopithecus chrysomelas) caused by Klebsiella pneumoniae subsp.pneumoniae during a translocation program of free-ranging animals in Brazil[J].J Vet Diagn Invest,2015,27(3):387-391.
[17] De Rosa FG,Corcione S,Cavallo R,et al.Critical issues for Klebsiella pneumoniae KPC-carbapenemase producing K.pneumoniae infections:a critical agenda[J].Future Microbiol,2015,10(2):283-294.
[18] Jiang Y,Shen P,Wei Z,et al.Dissemination of a clone carrying a fosA3-harbouring plasmid mediates high fosfomycinresistance rate of KPC-producing Klebsiella pneumoniae in China[J].Int J Antimicrob Agents,2015,45(1):66-70.
[19] Zhu Z,Kang Y,Lin Z,et al.X-linked agammaglobulinemia combined with juvenile idiopathic arthritis and invasive Klebsiella pneumoniae polyarticular septic arthritis[J].Clin Rheumatol,2015,34(2):397-401.
[20] 李晓如,李志军,王东强,等.APACHEⅡ APACHEⅢ评分及PSI评分评估老年重症肺炎预后的对比研究[J].中国急救医学,2015,35(11):1013-1016.
[21] Krishnamoorthy G,Kannan S,Marudhamuthu M.Bioactive compound from Aspergillus terreus DMTMGK004 synergistically contributes towards potential anti-pathogenicity[J].Lett Appl Microbiol,2018,67(6):579-588.
[2] 贺吉童,倪文涛,王睿,等.多黏菌素联合用药治疗产肺炎克雷伯菌碳青霉烯酶肺炎克雷伯菌体外研究进展[J].中国临床药理学杂志,2016,32(24):2315-2318.
[3] 陈玉宇,李辉军,许春燕,等.肺炎克雷伯菌产碳青霉烯酶特性与耐药趋势研究[J].中国微生态学杂志,2015,27(2):174-177.
[4] Liu Z,Gu Y,Li X,et al.Identification and characterization of NDM-1-producing hypervirulent (Hypermucoviscous) Klebsiella pneumoniae in China[J].Ann Lab Med,2019,39(2):167-175.
[5] Sun K,Chen X,Li C,et al.Clonal dissemination of multilocus sequence type 11 Klebsiella pneumoniae carbapenemase - producing K.pneumoniae in a Chinese teaching hospital[J].APMIS,2015,123(2):123-127.
[6] 吴芳,刘祖德,程志英,等.我院碳青霉烯类药物使用量与肺炎克雷伯菌耐药相关性分析[J].中国药房,2015,26(26):3660-3662.
[7] Marques AS,Moraes EP,Junior MAA,et al.Rapid discrimination of Klebsiella pneumoniae carbapenemase 2-producing and non-producing Klebsiella pneumoniae strains using near-infrared spectroscopy (NIRS) and multivariateanalysis[J].Talanta,2015,134:126-131.
[8] Lanne ABM,Goode A,Prattley C,et al.Molecular recognition of lipopolysaccharide by the lantibiotic nisin[J].Biochim Biophys Acta Biomembr,2019,1861(1):83-92.
[9] Irazazabal LN,Porto WF,Fensterseifer ICM,et al.Fast and potent bactericidal membrane lytic activity of PaDBS1R1,a novel cationic antimicrobial peptide[J].Biochim Biophys Acta Biomembr,2019,1861(1):178-190.
[10] 陈绍淳(综述),张娟(审校).产碳青霉烯酶的肺炎克雷伯菌耐药机制及流行病学研究进展[J].国际检验医学杂志,2016,37(23):3328-3330.
[11] Xie Y,Tian L,Li G,et al.Emergence of the third-generation cephalosporin-resistant hypervirulent Klebsiella pneumoniae due to the acquisition of a self-transferable blaDHA-1-carrying plasmid by an ST23 strain[J].Virulence,2018,9(1):838-844.
[12] Codo AC,Saraiva AC,Dos Santos LL,et al.Inhibition of inflammasome activation by a clinical strain of Klebsiella pneumoniae impairs efferocytosis and leads to bacterial dissemination[J].Cell Death Dis,2018,9(12):1182.
[13] 黄伟丽,周杰,李奇峰,等.我院ICU脑干出血患者医院感染病原菌分布及耐药性分析[J].中国药房,2017,28(2):182-185.
[14] Khan FA,Hellmark B,Ehricht R,et al.Related carbapenemase-producing Klebsiella isolates detected in both a hospital and associated aquatic environment in Sweden[J].Eur J Clin Microbiol Infect Dis,2018,37(12):2241-2251.
[15] Pan DT,Wang XD,Shi HY,et al.Dynamic flux balance analysis for microbial conversion of glycerol into 1,3-propanediol by Klebsiella pneumoniae[J].Bioprocess Biosyst Eng,2018,41(12):1793-1805.
[16] Bueno MG,Iovine RO,Torres LN,et al.Pneumonia and bacteremia in a golden-headed lion tamarin (Leontopithecus chrysomelas) caused by Klebsiella pneumoniae subsp.pneumoniae during a translocation program of free-ranging animals in Brazil[J].J Vet Diagn Invest,2015,27(3):387-391.
[17] De Rosa FG,Corcione S,Cavallo R,et al.Critical issues for Klebsiella pneumoniae KPC-carbapenemase producing K.pneumoniae infections:a critical agenda[J].Future Microbiol,2015,10(2):283-294.
[18] Jiang Y,Shen P,Wei Z,et al.Dissemination of a clone carrying a fosA3-harbouring plasmid mediates high fosfomycinresistance rate of KPC-producing Klebsiella pneumoniae in China[J].Int J Antimicrob Agents,2015,45(1):66-70.
[19] Zhu Z,Kang Y,Lin Z,et al.X-linked agammaglobulinemia combined with juvenile idiopathic arthritis and invasive Klebsiella pneumoniae polyarticular septic arthritis[J].Clin Rheumatol,2015,34(2):397-401.
[20] 李晓如,李志军,王东强,等.APACHEⅡ APACHEⅢ评分及PSI评分评估老年重症肺炎预后的对比研究[J].中国急救医学,2015,35(11):1013-1016.
[21] Krishnamoorthy G,Kannan S,Marudhamuthu M.Bioactive compound from Aspergillus terreus DMTMGK004 synergistically contributes towards potential anti-pathogenicity[J].Lett Appl Microbiol,2018,67(6):579-588.