血液分离耐碳青霉烯类肺炎克雷伯菌耐药性及相关危险因素

Antimicrobial resistance and related risk factors of carbapenem-resistant Klebsiella pneumoniae isolated from blood

摘要:

目的 探讨血液分离耐碳青霉烯类肺炎克雷伯菌(CRKP)的耐药性及患者感染的相关危险因素。 方法 回顾性分析2018年1月—2021年12月在某院住院并从血液中分离出肺炎克雷伯菌(KP)的383例KP感染患者的临床资料, 依据耐药情况分为CRKP组(114例)和non-CRKP组(269例), 根据预后情况将114例CRKP组患者分为两个亚组: 死亡组(30例)和存活组(84例), 分别比较两组患者的一般资料、基础疾病、抗菌药物使用情况和感染结局等, 并分析患者感染及感染后死亡的危险因素。 结果 KP对替加环素和复方磺胺甲口恶唑的耐药率呈上升趋势, 差异均有统计学意义(均P=0.008)。CRKP组对阿米卡星、氨曲南、复方磺胺甲口恶唑、环丙沙星、头孢吡肟、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、替加环素、头孢他啶、妥布霉素和左氧氟沙星的耐药率及患者住院病死率均高于non-CRKP组, 差异均有统计学意义(均P＜0.05)。感染前患有急性胰腺炎(OR=16.564, P＜0.001)、低蛋白血症(OR=8.588, P＜0.001)、感染前入住重症监护病房(OR=2.733, P=0.017)、输血(OR=3.968, P=0.001)、支气管镜检查(OR=5.194, P=0.014)、感染前30 d内手术(OR=2.603, P=0.010)和接受碳青霉烯类药物治疗(OR=2.663, P=0.011)是发生CRKP血流感染(BSI)的独立危险因素。感染前患有心功能不全(OR=11.094, P=0.001)、合并肺部感染(OR=20.801, P=0.010)、感染性休克(OR=9.783, P=0.002)、意识障碍(OR=11.648, P=0.001)和接受糖皮质激素治疗(OR=5.333, P=0.018)是BSI CRKP患者死亡的独立危险因素。 结论 BSI分离的KP对替加环素和复方磺胺甲口恶唑的耐药率呈上升趋势, 基础疾病、侵入性操作和碳青霉烯类药物治疗与CRKP BSI密切相关, 心功能不全、肺部感染、感染性休克、意识障碍和糖皮质激素治疗可导致BSI CRKP患者死亡。

Abstract:

Objective To explore the antimicrobial resistance of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated from blood and the related risk factors for infection in patients. Methods Clinical data of 383 KP-infected patients from whose blood Klebsiella pneumoniae (KP) were isolated during hospitalization period in a hospital from January 2018 to December 2021 were retrospectively analyzed. Patients were divided into CRKP group (n=114) and non-CRKP group (n=269) based on antimicrobial resistance. According to the prognosis, 114 patients in the CRKP group were subdivided into the death group (n=30) and the survival group (n=84). General information, underlying diseases, antimicrobial use, and infection outcomes of two groups of patients were compared, and risk factors for infection and death after infection were analyzed. Results The resistance rates of KP to tigecycline and compound sulfamethoxazole showed upward trends, with statistically significant differences (both P=0.008). The CRKP group had higher resistance rates to amikacin, aztreonam, compound sulfamethoxazole, ciprofloxacin, cefepime, cefoperazone/sulbactam, piperacillin/tazobactam, tigecycline, ceftazidime, tobramycin, and levofloxacin, as well as higher in-hospital mortality than the non-CRKP group, with statistically significant differences (all P < 0.05). Acute pancreatitis prior to infection (OR=16.564, P < 0.001), hypoalbuminemia (OR=8.588, P < 0.001), stay in intensive care unit prior to infection (OR=2.733, P=0.017), blood transfusion (OR=3.968, P=0.001), bronchoscopy (OR=5.194, P=0.014), surgery within 30 days prior to infection (OR=2.603, P=0.010), and treatment with carbapenems (OR=2.663, P=0.011) were independent risk factors for the development of CRKP bloodstream infection (BSI). Cardiac insufficiency before infection (OR=11.094, P=0.001), combined with pulmonary infection (OR=20.801, P=0.010), septic shock (OR=9.783, P=0.002), disturbance of consciousness (OR=11.648, P=0.001), and receiving glucocorticoid treatment (OR=5.333, P=0.018) were independent risk factors for mortality in patients with CRKP BSI. Conclusion The resistance rate of KP from BSI to tigecycline and compound sulfamethoxazole presents upward trend. Underlying diseases, invasive procedures, and carbapenem treatment are closely related to CRKP BSI. Cardiac insufficiency, pulmonary infection, septic shock, disturbance of consciousness, and glucocorticoid treatment can lead to death of patients with CRKP BSI.