耐碳青霉烯类肺炎克雷伯菌（CrKP）重症患者的临床特征及危险因素：一项来自发展中国家的队列研究
Clinical Characteristics and Risk Factors for Critically Ill Patients with Carbapenem-Resistant (CrKP): A Cohort Study from Developing Country.
作者信息
Luan Ying-Yi, Chen Yan-Hong, Li Xue, Zhou Zhi-Peng, Huang Jia-Jia, Yang Zhen-Jia, Zhang Jing-Jing, Wu Ming
机构信息
Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, People's Republic of China.
Department of Critical Care Medicine and Hospital Infection Prevention and Control, Shenzhen Second People`s Hospital & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, 518035, People's Republic of China.
出版信息
Infect Drug Resist. 2021 Dec 20;14:5555-5562. doi: 10.2147/IDR.S343489. eCollection 2021.
BACKGROUND
Increasing evidence indicates carbapenem-resistant (CrKP) is increasingly prevalent in intensive care unit (ICU), but its clinical characteristics and risk factors remain unknown.
AIM
The aim of the present study was to evaluate clinical characteristics, risk factors in critically ill patients with CrKP infection.
METHODS
A retrospective study was included in patients from January 2013 to October 2019. Clinical data were collected from CrKP patients on the day of specimen collection admitted to ICU. Multivariable logistic regression was used for risk factors. Receiver operating curve (ROC) and the area under the curve (AUC) with DeLong method of MedCalc software were used. Two-way repeated-measures ANOVA analysis was used to analyze the characteristics of independent risk factors over time.
FINDINGS
A total of 147 adult patients with CrKP were screened, among them, 89 (median age 64.0 years, 66 (74.15%) males) patients with CrKP were finally included, of which 38 patients (42.7%) were non-survival group. Multivariate logistic regression analysis indicated that lactic acid (OR3.04 95% CI 1.38-6.68, P = 0.006), APACHE II score (OR 1.20, 95% CI 1.09-1.33, P < 0.001), tigecycline combined with fosfomycin treatment (OR0.15, 95% CI 0.04-0.65, P = 0.011) are independent risk factors for 28-day mortality in patients with CRKP infection (<0.05). Combined lactic acid with APACHE II score could predict 28-day mortality, of which AUC value was 0.916 (95% CI, 0.847-0.985), with sensitivity 0.76 and specificity 0.98. ANOVA analysis showed that APACHE II score and lactic acid between the two groups at three-time points were statistically significant, which interactive with time and showed an upward and downward trend with time (P < 0.05).
CONCLUSION
Therapeutic strategy based on improving lactic acid and APACHE II would contribute to the outcome in patients with CrKP infection. Tigecycline combined with fosfomycin could reduce the 28-day mortality in patients with CrKP infection in developing country.
背景
越来越多的证据表明，耐碳青霉烯类肺炎克雷伯菌（CrKP）在重症监护病房（ICU）中越来越普遍，但其临床特征和危险因素仍然未知。
目的
本研究的目的是评估CrKP感染的重症患者的临床特征和危险因素。
方法
纳入2013年1月至2019年10月的患者进行回顾性研究。从入住ICU的CrKP患者标本采集当天收集临床数据。采用多变量逻辑回归分析危险因素。使用MedCalc软件的DeLong方法绘制受试者工作特征曲线（ROC）和曲线下面积（AUC）。采用双向重复测量方差分析来分析独立危险因素随时间的变化特征。
结果
共筛查了147例成年CrKP患者，其中最终纳入89例（中位年龄64.0岁，66例（74.15%）为男性）CrKP患者，其中38例患者（42.7%）为非生存组。多变量逻辑回归分析表明，乳酸（OR 3.04，95%CI 1.38 - 6.68，P = 0.006）、急性生理与慢性健康状况评分系统II（APACHE II）评分（OR 1.20，95%CI 1.09 - 1.33，P < 0.001）、替加环素联合磷霉素治疗（OR 0.15，95%CI 0.04 - 0.65，P = 0.011）是CRKP感染患者28天死亡率的独立危险因素（P < 0.05）。乳酸与APACHE II评分联合可预测28天死亡率，其AUC值为0.916（95%CI，0.847 - 0.985），敏感性为0.76，特异性为0.98。方差分析表明，APACHE II评分和乳酸在三个时间点的两组间差异有统计学意义，它们与时间存在交互作用，并随时间呈上升和下降趋势（P < 0.05）。
结论
基于改善乳酸水平和APACHE II评分的治疗策略将有助于改善CrKP感染患者的预后。在发展中国家，替加环素联合磷霉素可降低CrKP感染患者的28天死亡率。
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