Department of Pharmacy, The First Hospital of Changsha, Changsha, Hunan, China (mainland).
Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland).
Med Sci Monit. 2020 Oct 24;26:e925693. doi: 10.12659/MSM.925693.
BACKGROUND The increased prevalence of carbapenem-resistant K. pneumoniae (CRKP) poses a great threat worldwide. Early identification of CRKP in patients is paramount. Moreover, fully understanding the risk factors affecting clinical outcome and actively providing targeted treatment can improve the cure rate of patients with CRKP. Therefore, our study aimed to describe the clinical characteristics and identify the risk factors affecting clinical outcomes in patients with CRKP. MATERIAL AND METHODS From January 2016 to September 2017, CRKP strains and clinical data from 97 hospitalized patients were collected. We first performed an antibiotic susceptibility test on CRKP strains using the Kirby-Bauer disc agar diffusion method. Logistic regression analysis was then performed to analyze risk factors. RESULTS According to clinical outcome, among the 97 CRKP patients, 67 were in the effective group and 30 patients were in the noneffective group. Risk factors found to correlate with poor clinical outcome in patients with CRKP included ICU admission, arteriovenous catheterization, indwelling gastric tube, indwelling urethral catheter, tracheal intubation, mechanical ventilation, hypoproteinemia, and exposure to carbapenems. Multivariate analysis showed that hypoproteinemia (OR: 2.83, p=0.042), presence of an indwelling gastric tube (OR: 4.54, p=0.005), and exposure to carbapenems (OR: 2.77, p=0.045) negatively affected clinical outcome in patients with CRKP. CONCLUSIONS Adverse risk factors correlated with poor clinical outcomes in patients with CRKP were determined. This could be of help in identifying high-risk patients with whom clinicians should take extra precautions and adjust therapeutic strategy to supplement conventional basic treatment with additional measures.
碳青霉烯类耐药肺炎克雷伯菌（CRKP）的流行率增加在全球范围内构成了巨大威胁。尽早在患者中识别 CRKP 至关重要。此外，充分了解影响临床结果的危险因素，并积极提供针对性治疗，可以提高 CRKP 患者的治愈率。因此，我们的研究旨在描述 CRKP 患者的临床特征，并确定影响临床结果的危险因素。
本研究于 2016 年 1 月至 2017 年 9 月期间，收集了 97 例住院患者的 CRKP 菌株和临床数据。我们首先使用 Kirby-Bauer 纸片琼脂扩散法对 CRKP 菌株进行抗生素敏感性试验，然后进行 logistic 回归分析以分析危险因素。
根据临床结果，在 97 例 CRKP 患者中，67 例为有效组，30 例为无效组。与 CRKP 患者临床结果不良相关的危险因素包括 ICU 入住、动静脉置管、留置胃管、留置导尿管、气管插管、机械通气、低蛋白血症和碳青霉烯类暴露。多因素分析显示，低蛋白血症（OR：2.83，p=0.042）、存在留置胃管（OR：4.54，p=0.005）和碳青霉烯类暴露（OR：2.77，p=0.045）与 CRKP 患者的临床结果不良相关。
确定了与 CRKP 患者临床结果不良相关的不利危险因素。这有助于识别高风险患者，临床医生应格外小心，并调整治疗策略，在常规基础治疗的基础上补充额外的措施。
