Man M Y, Shum H P, Chan Y H, Chan K C, Yan W W, Lee R A, Lau S K P
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
J Hosp Infect. 2017 Sep;97(1):35-41. doi: 10.1016/j.jhin.2017.06.007. Epub 2017 Jun 9.
Klebsiella pneumoniae (KP) infection is associated with high morbidity and mortality. Multidrug resistance, especially extended-spectrum β-lactamase (ESBL) production, in KP is endemic worldwide.
To evaluate the clinical characteristics and outcomes of patients with KP bacteraemia in critical care and general ward settings.
Adult patients admitted to a regional hospital in Hong Kong from January 1, 2009 to June 30, 2016 (7.5 years) with KP bacteraemia were included. Demographics, clinical features, microbiological characteristics, and outcomes were analysed.
Among 853 patients, 178 (20.9%) required critical care and 176 (20.6%) died within 30 days of hospital admission. Thirty-day survivors were younger (P<0.001), had milder disease (defined by Sequential Organ Failure Assessment score) (P<0.001), presented with hepatobiliary sepsis (P<0.001) or urosepsis (P<0.001), less septic shock (P=0.013), fewer invasive organ supports (P<0.001), and had appropriate empirical antibiotics (P<0.001). Cox regression analysis showed that respiratory tract infection (hazard ratio: 2.99; 95% confidence interval: 2.061-4.337; P≤0.001), gastrointestinal tract infection (excluding hepatobiliary system) (2.763; 1.761-4.337; P≤0.001), mechanical ventilation (2.202; 1.506-3.221; P≤0.001), medical case (1.830; 1.253-2.672; P=0.002), inappropriate empirical antibiotics (1.716; 1.267-2.324; P≤0.001), female (1.699; 1.251-2.307; P<0.001), age >65 years (1.692; 1.160-2.467; P=0.006), and presence of solid tumour (1.457; 1.056-2.009; P=0.022) were independent risk factors for 30-day mortality. Unexpectedly, diabetes mellitus was associated with better 30-day survival (P=0.002). A total of 102 patients (12.0%) had infections with ESBL-producing strains, which were not associated with higher 30-day mortality.
KP bacteraemia is associated with high 30-day mortality. Site of infection, patients' comorbidities and appropriate use of empirical antibiotic are important predictors of patients' outcomes.
肺炎克雷伯菌（KP）感染与高发病率和死亡率相关。KP中的多重耐药，尤其是超广谱β-内酰胺酶（ESBL）的产生，在全球范围内普遍存在。
评估重症监护病房和普通病房中KP菌血症患者的临床特征和预后。
纳入2009年1月1日至2016年6月30日（7.5年）在香港一家地区医院住院的成年KP菌血症患者。分析人口统计学、临床特征、微生物学特征和预后。
853例患者中，178例（20.9%）需要重症监护，176例（20.6%）在入院30天内死亡。30天幸存者更年轻（P<0.001），疾病较轻（由序贯器官衰竭评估评分定义）（P<0.001），表现为肝胆系统感染（P<0.001）或泌尿系统感染（P<0.001），感染性休克较少（P=0.013），侵入性器官支持较少（P<0.001），且使用了合适的经验性抗生素（P<0.001）。Cox回归分析显示，呼吸道感染（风险比：2.99；95%置信区间：2.061 - 4.337；P≤0.001）、胃肠道感染（不包括肝胆系统）（2.763；1.761 - 4.337；P≤0.001）、机械通气（2.202；1.506 - 3.221；P≤0.001）、内科病例（1.830；1.253 - 2.672；P=0.002）、经验性抗生素使用不当（1.716；1.267 - 2.324；P≤0.001）、女性（1.699；1.251 - 2.307；P<0.001）、年龄>65岁（1.692；1.160 - 2.467；P=0.006）和实体瘤存在（1.457；1.056 - 2.009；P=0.022）是30天死亡率的独立危险因素。出乎意料的是，糖尿病与30天更好的生存率相关（P=0.002）。共有102例患者（12.0%）感染产ESBL菌株，其与30天较高死亡率无关。
KP菌血症与30天高死亡率相关。感染部位、患者合并症和经验性抗生素的合理使用是患者预后的重要预测因素。
