Zheng Xia, Wang Jian-Feng, Xu Wang-Lan, Xu Jun, Hu Juan
Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 People's Republic of China.
Department of Respiratory Diseases, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, No. 126 Wenzhou Road, Hangzhou, 310009 People's Republic of China.
Antimicrob Resist Infect Control. 2017 Oct 2;6:102. doi: 10.1186/s13756-017-0256-2. eCollection 2017.
To analyze the clinical characteristics and outcomes of carbapenem-resistant (CRKp) and carbapenem-susceptible (CSKp) bloodstream infections (BSIs), and to study the risk factors for development of CRKp BSI and BSI-related mortality.
A retrospective case control study of patients with BSI was conducted in the intensive care unit of the First Affiliated Hospital, Medical of College, Zhejiang University from January 2013 to December 2014. Carbapenem resistance was defined in accordance with the Clinical and Laboratory Standards Institute 2016 guidelines. Risk factors for the development of CRKp BSI and risk factors for mortality due to BSI were assessed. Virulence genes were detected by polymerase chain reaction assay.
In total, 48 patients were enrolled in the study, including 31 (65%) patients with CRKp BSI and 17 (35%) patients with CSKp BSI. CSKp infection was associated with more severe clinical symptoms, particularly a higher serum creatinine level (165.06 ± 127.01 in the CSKp group vs. 93.77 ± 84.35 μmol/L in the CRKp group, 0.039), but there was no significant difference in prognosis between the CSKp and CRKp groups. On multivariate analysis, indwelling central venous catheter ( 0.045) was the only factor independently associated with CRKp bacteremia. However, the mortality of BSI patients was not correlated with carbapenem resistance. In addition, the isolates had diverse clonality and different origins. The frequency of detection of the and virulence genes was higher in the CSKp group than in the CRKp group ( 0.04; 0.047).
Patients in the CSKp group experienced more severe clinical symptoms, although mortality did not differ significantly between the CRKp and CSKp groups. An indwelling central venous catheter was the only factor independently associated with CRKp BSI. The mortality of patients with BSI was not associated with carbapenem resistance. The frequency of virulence genes was higher in the CSKp group than in the CRKp group.
分析耐碳青霉烯类肺炎克雷伯菌（CRKp）血流感染（BSI）和对碳青霉烯类敏感的肺炎克雷伯菌（CSKp）血流感染的临床特征及转归，并研究CRKp血流感染发生及血流感染相关死亡的危险因素。
对2013年1月至2014年12月浙江大学医学院附属第一医院重症监护病房中发生血流感染的患者进行回顾性病例对照研究。根据临床和实验室标准协会2016年指南定义碳青霉烯类耐药。评估CRKp血流感染发生的危险因素及血流感染导致死亡的危险因素。采用聚合酶链反应检测毒力基因。
本研究共纳入48例患者，其中31例（65%）为CRKp血流感染患者，17例（35%）为CSKp血流感染患者。CSKp感染与更严重的临床症状相关，尤其是血清肌酐水平更高（CSKp组为165.06±127.01，CRKp组为93.77±84.35μmol/L，P=0.039），但CSKp组和CRKp组的预后无显著差异。多因素分析显示，留置中心静脉导管（P=0.045）是与CRKp菌血症独立相关的唯一因素。然而，血流感染患者的死亡率与碳青霉烯类耐药无关。此外，分离株具有不同的克隆性和来源。CSKp组中a和b毒力基因的检测频率高于CRKp组（P=0.04；P=0.047）。
CSKp组患者临床症状更严重，尽管CRKp组和CSKp组的死亡率无显著差异。留置中心静脉导管是与CRKp血流感染独立相关的唯一因素。血流感染患者的死亡率与碳青霉烯类耐药无关。CSKp组毒力基因的频率高于CRKp组。
