摘要
目的探讨呼吸衰竭患者并发耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的病原菌特征、危险因素及其对患者预后的影响。方法收集2022年1月至2024年7月期间本院呼吸重症医学科确诊的呼吸衰竭并培养阳性CRKP感染患者病例,全基因组测序分析CRKP的耐药基因型及其分布情况。收集患者的临床资料,包括人口学特征、基础疾病、抗生素使用及预后数据。采用单因素分析筛选与CRKP感染相关的显著变量,并通过多因素Logistic回归模型识别独立危险因素,同时评估感染组与非感染组在死亡率及其他不良结局上的差异。结果共纳入136例呼吸衰竭患者,其中58例并发CRKP感染(感染组),78例无CRKP感染(非感染组)。分离的58株肺炎克雷伯菌中,耐药基因bla_KPC检出率最高(67.27%),其次为bla_NDM(24.13%)和bla_OXA-48(8.66%);87.93%的菌株表现多重耐药性。分子分型分析显示,ST11为主要克隆型(72.41%),主要携带bla_KPC基因,ST258(13.79%)以bla_NDM基因为主。多因素Logistic回归分析表明,抗生素使用(OR=8.207,95%CI:1.068-63.065,P=0.043)、插管时间(OR=1.249,95%CI:1.059-1.473,P=0.008)及C反应蛋白水平(OR=1.111,95%CI:1.054-1.172,P<0.001)是CRKP感染的独立危险因素。感染组28d死亡率和院内死亡率显著高于非感染组(50.0%vs.16.7%,P<0.001;55.2%vs.21.8%,P<0.001),且感染组患者的机械通气时间(22.4±6.1dvs.14.3±5.7d,P<0.001)、血液净化治疗时间(4.7±2.3dvs.2.1±1.4d,P<0.001)及急性肾损伤发生率(39.7%vs.19.2%,P=0.009)均显著高于非感染组。感染清除率和复发率分别为67.2%和15.5%。CRKP感染显著增加住院费用(23.7±4.8万元vs.14.6±3.2万元,P<0.001),对预后及医疗资源造成严重影响。结论CRKP在呼吸衰竭患者中具有高度耐药性,其感染的独立危险因素包括抗生素使用、插管时间和CRP水平升高。CRKP感染显著增加患者死亡率、住院时间和医疗资源消耗。针对高危患者的早期筛查与精准干预是改善预后的关键。
Objective To investigate the pathogenic bacteria characteristics,risk factors and impact on prognosis of carbapenem-resistant Klebsiella pneumoniae(CRKP)infection in patients with respiratory failure.MethodsP Iatients with respiratory failure and culture-positive CRKP infection diagnosed in the Department of Respiratory and Critical Care Medicine of our hospital from January 2022 to July 2024 were collected,and the drug-resistant genotypes and their distribution of CRKP were analyzed by whole genome sequencing.The clinical data of the patients,including demographic characteristics,underlying diseases,antibiotic use,and prognosis data,were collected.Univariate analysis was used to screen significant variables associated with CRKP infection,and a multivariate logistic regression model was used to identify independent risk factors.The differences in mortality and other adverse outcomes between the infection group and the non-infection group were also evaluated.Results A total of 136 patients with respiratory failure were included,of which 58 were complicated by CRKP infection(infection group)and 78 were not infected with CRKP(non-infection group).Among the 58 isolated Klebsiella pneumoniae strains,the detection rate of drug-resistant gene bla_KPC was the highest(67.27%),followed by bla_NDM(24.13%)and bla_OXA-48(8.66%);87.93%of the strains showed multidrug resistance.Molecular typing analysis showed that ST11 was the main clonal type(72.41%),mainly carrying bla_KPC gene,and ST258(13.79%)was mainly bla_NDM gene.Multivariate logistic regression analysis showed that antibiotic use(OR=8.207,95%CI:1.068-63.065,P=0.043),intubation time(OR=1.249,95%CI:1.059-1.473,P=0.008)and C-reactive protein level(OR=1.111,95%CI:1.054-1.172,P<0.001)were independent risk factors for CRKP infection.The 28-day mortality and in-hospital mortality of the infection group were significantly higher than those of the non-infection group(50.0%vs.16.7%,P<0.001;55.2%vs.21.8%,P<0.001),and the duration of mechanical ventilation(22.4±6.1 d vs.14.3±5.7 d,P<0.001),blood purification treatment(4.7±2.3 d vs.2.1±1.4 d,P<0.001)and incidence of acute kidney injury(39.7%vs.19.2%,P=0.009)in the infection group were significantly higher than those of the non-infection group.The infection clearance rate and recurrence rate were 67.2%and 15.5%,respectively.CRKP infection significantly increased hospitalization costs(237000±48000 yuan vs.146000±32000 yuan,P<0.001),which had a serious impact on prognosis and medical resources.ConclusionCRKP is highly resistant in patients with respiratory failure,and independent risk factors for infection include antibiotic use,intubation time,and elevated CRP levels.CRKP infection significantly increases patient mortality,length of hospital stay,and consumption of medical resources.Early screening and precise intervention for high-risk patients are the key to improving prognosis.
作者
王丹
常阳阳
丁晗
WANG Dan;CHANG Yangyang;DING Han(Respiratory ICU,Huaihe Hospital,Henan University,Kaifeng 475000,Henan,China)
出处
《中国病原生物学杂志》
北大核心
2025年第4期445-449,共5页
Journal of Pathogen Biology
关键词
呼吸衰竭
耐碳青霉烯类肺炎克雷伯菌
病原菌特征
危险因素
预后分析
respiratory failure
carbapenem-resistant Klebsiella pneumoniae
pathogen characteristics
risk factors
prognosis analysis
