Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Centre for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Department of Infectious Diseases, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China.
Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Centre for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
J Infect. 2022 May;84(5):637-647. doi: 10.1016/j.jinf.2022.03.010. Epub 2022 Mar 14.
To elucidate the predictors of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and help clinicians better identify CRKP infection at an early stage.
We conducted a multicentre case-control study of 422 patients with CRKP infection and 948 with carbapenem-susceptible K. pneumoniae (CSKP) infection from March to July 2017. Binary logistic regression was used to identify risk factors for CRKP infection. The subgroups of CRKP respiratory infection, intra-abdominal infection, and bloodstream infection were also evaluated. Patients were followed up for 28 days. Independent risk factors for 28-day crude mortality of CRKP infection were analysed using Cox proportional hazards regression models.
Longer stay of hospitalization, stay in the intensive care unit (ICU), previous exposure to antibacterial agents (especially carbapenems, quinolones, aminoglycosides, and tigecycline), invasive procedures, intravascular catheter use, tracheotomy, and admission to ICU in the preceding 90 days were risk factors for CRKP infection. Carbapenem exposure was the only common predictor of different types of CRKP infection. The 28-day crude mortality of CRKP infection was 24.2% and was independently associated with sex, admitted unit, and type of infection.
Strict policies for antibiotic use, cautious decisions regarding the implementation of invasive procedures, and careful management of patients with catheters, especially intravascular catheters, are necessary to handle CRKP infection.
阐明耐碳青霉烯肺炎克雷伯菌（CRKP）感染的预测因素，帮助临床医生在早期更好地识别 CRKP 感染。
我们对 2017 年 3 月至 7 月期间的 422 例 CRKP 感染患者和 948 例碳青霉烯敏感肺炎克雷伯菌（CSKP）感染患者进行了一项多中心病例对照研究。采用二项逻辑回归分析确定 CRKP 感染的危险因素。还评估了 CRKP 呼吸道感染、腹腔内感染和血流感染亚组。对患者进行了 28 天的随访。采用 Cox 比例风险回归模型分析 CRKP 感染 28 天粗死亡率的独立危险因素。
住院时间较长、入住重症监护病房（ICU）、抗菌药物（尤其是碳青霉烯类、喹诺酮类、氨基糖苷类和替加环素）暴露史、有创操作、血管内导管使用、气管切开术以及 90 天内入住 ICU 是 CRKP 感染的危险因素。碳青霉烯类药物暴露是不同类型 CRKP 感染的唯一共同预测因素。CRKP 感染的 28 天粗死亡率为 24.2%，与性别、入院科室和感染类型独立相关。
严格的抗生素使用政策、谨慎决定实施有创操作以及仔细管理导管患者（尤其是血管内导管）对于处理 CRKP 感染是必要的。
