CRKP医院感染/定植对ICU患者死亡风险的影响
Influence of CRKP infection/colonization on mortality risk of ICU patients
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摘要:目的 探究耐碳青霉烯类肺炎克雷伯菌(CRKP)感染/定植对重症监护病房(ICU)患者死亡风险的影响。方法 选择2016年1月1日-2018年12月31日四川大学华西医院ICU住院患者为研究对象, 采用回顾性队列研究, 根据是否在ICU内从临床标本检出CRKP将患者分为CRKP感染/定植组与非CRKP感染/定植组, 采用Kaplan-Meier法分析CRKP感染/定植组与非CRKP感染/定植组30 d的死亡风险, 采用Cox比例风险模型分析ICU患者30 d死亡风险的影响因素。结果 共纳入2 229例患者, 其中CRKP感染/定植组患者89例, 非CRKP感染/定植组患者2 140例, CRKP感染/定植患者标本来源以痰液为主, 感染部位以下呼吸道为主。CRKP感染/定植组30 d生存率为66.49%, 非CRKP感染/定植患者30 d生存率为78.49%, 差异有统计学意义(χ2=7.200, P=0.007), Cox比例风险模型分析显示, CRKP感染/定植会增加ICU患者30 d内死亡风险(HR=1.839, 95%CI：1.126~3.002, P=0.015)；年龄(HR=1.014, 95%CI：1.006~1.022, P＜0.001)、APACHEⅡ(HR=1.035, 95%CI：1.018~1.053, P＜0.001)、使用卡泊芬净(HR=1.398, 95%CI：1.038~1.882, P=0.028)、中心静脉置管(HR=3.752, 95%CI：1.808~7.790, P＜0.001)和血液净化(HR=2.061, 95%CI：1.518~2.797, P＜0.001)也会增加ICU患者30 d死亡风险。结论 相比于非CRKP感染/定植患者, CRKP感染/定植患者30 d内死亡风险较高, 应制定CRKP感染/定植的预防与控制措施并落实, 减少CRKP感染/定植的发生, 并采取措施降低患者病死率, 改善患者的预后。Abstract:OBJECTIVE To observe the influence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection/colonization on mortality risk of the intensive care unit (ICU) patients.METHODS The patients who were hospitalized in ICUs of West China Hospital of Sichuan University from Jan. 1, 2016 to Dec. 31, 2018 were recruited as the research subjects. By means of retrospective cohort study, the enrolled patients were divided into the CRKP infection/colonization group and the non-CRKP infection/colonization group according to the status of isolation of CRKP strains from the clinical specimens of the ICU patients. The 30-day mortality risk of the CRKP infection/colonization group and the non-CRKP infection/colonization group was analyzed by Kaplan-Meier. The influencing factors for the 30-day mortality risk of the ICU patients were analyzed by means of Cox proportional hazard model.RESULTS A total of 2229 patients were enrolled in the study, of which 89 were assigned as the CRKP infection/colonization group, and 2140 were assigned as the non-CRKP infection/colonization group. The sputum was the major specimen source from the patients with CRKP infection/colonization, and the lower respiratory tract was the major infection site. The 30-day survival rate was 66.49% in the CRKP infection/colonization group, 78.49% in the non-CRKP infection/colonization group, and there was significant difference (χ2=7.200, P=0.007). The Cox proportional hazard model analysis showed that the CRKP infection/colonization could increase the 30-day mortality risk of the ICU patients (HR=1.839, 95%CI: 1.126 to 3.002, P=0.015); the age (HR=1.014, 95%CI: 1.006 to 1.022, P < 0.001), APACHEⅡ (HR=1.035, 95%CI: 1.018 to 1.053, P < 0.001), use of caspofungin (HR=1.398, 95%CI: 1.038 to 1.882, P=0.028), central venous catheter indwelling (HR=3.752, 95%CI: 1.808 to 7.790, P < 0.001) and blood purification (HR=2.061, 95%CI: 1.518 to 2.797, P < 0.001) may also increase the 30-day mortality risk of the ICU patients.CONCLUSIONS The CRKP infection/colonization patients are at higher 30-day mortality risk than the non-CRKP infection/colonization patients. It is necessary to formulate and implement the prevention and control measures to reduce the incidence of CRKP infection/colonization and take measures to reduce the mortality rate of the patients so as to improve the prognosis.
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