Liu Xiaolei, Sai Fangfang, Li Lanyu, Zhu Changqing, Huang Huan
Department of Emergency Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Geriatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Ann Palliat Med. 2020 Sep;9(5):2668-2677. doi: 10.21037/apm-20-1052. Epub 2020 Sep 10.
The clinical characteristics and risk factors of catheter-associated urinary tract infections (CAUTIs) caused by Klebsiella pneumoniae (KP) have not been well investigated.
This retrospective study performed at a university teaching hospital in China from January 2012 to November 2017 analyzed data for 227 patients with urinary tract infection (UTI) caused by KP. Patients' demographic characteristics and clinical outcomes were recorded. Risk factors were analyzed using a binary logistic regression model.
Of 227 patients with Klebsiella pneumoniae-related urinary tract Infection (KP-UTI), the infection was catheter-associated in 90 patients. More than half of them were male (60%), over 60 years old, hospitalized in general ward, always acquired in hospital, and got a longer hospitalization more than one month. The Klebsiella pneumoniae-related catheter-associated urinary tract infections (KP-CAUTIs) patients always combined with lots of chronic comorbidities. A high proportion of invasive device, extendedspectrum β-lactamase (ESBL) expression and multidrug resistance (MDR) were found in KP-CAUTIs patients. When taken antimicrobial activity into consideration, KP-CAUTIs patients performed resistance to most antibiotics in varying degrees. Logistic regression analysis revealed that after grouping by ESBL expression and in-hospital mortality among patients with KP-CAUTI, complicated urinary tract infection (cUTI) was an independent risk factor for ESBL positive KP-CAUTIs [odds ratio (OR) 59.256; 95% CI, 3.417-1,027.628; P=0.005], whereas congestive heart failure was identified as an independent risk factor for in-hospital mortality (OR 25.592; 95% CI, 2.376-275.629; P=0.008) in KP-CAUTI patients.
Patients with KP-CAUTI displayed distinctive characteristics. cUTI and congestive heart failure were independently associated with ESBL expression and in-hospital mortality in patients with KPCAUTI.
肺炎克雷伯菌（KP）引起的导管相关尿路感染（CAUTIs）的临床特征和危险因素尚未得到充分研究。
本回顾性研究于2012年1月至2017年11月在中国一所大学教学医院进行，分析了227例由KP引起的尿路感染（UTI）患者的数据。记录患者的人口统计学特征和临床结局。使用二元逻辑回归模型分析危险因素。
在227例肺炎克雷伯菌相关尿路感染（KP-UTI）患者中，90例感染与导管相关。其中一半以上为男性（60%），年龄超过60岁，在普通病房住院，感染常在医院获得，住院时间超过1个月。肺炎克雷伯菌相关导管相关尿路感染（KP-CAUTIs）患者常合并多种慢性合并症。KP-CAUTIs患者中侵袭性器械使用比例高、超广谱β-内酰胺酶（ESBL）表达和多重耐药（MDR）比例高。考虑抗菌活性时，KP-CAUTIs患者对大多数抗生素有不同程度的耐药。逻辑回归分析显示，在按ESBL表达和KP-CAUTI患者院内死亡率分组后，复杂性尿路感染（cUTI）是ESBL阳性KP-CAUTIs的独立危险因素[比值比（OR）59.256；95%可信区间，3.417-1027.628；P=0.005]，而充血性心力衰竭被确定为KP-CAUTI患者院内死亡的独立危险因素（OR 25.592；95%可信区间，2.376-275.629；P=0.008）。
KP-CAUTI患者表现出独特的特征。cUTI和充血性心力衰竭分别与KP-CAUTI患者的ESBL表达和院内死亡率独立相关。
