Ouyang Pengwen, Zhou Zhijie, Pan Chanyuan, Tang Peijuan, Long Sheng, Liao Xiangjian, Liu Qiong, Xie Liangyi
Department of Clinical Laboratory, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, People's Republic of China.
Department of Respiratory Medicine, The Affiliated Zhuzhou Hospital of Xiangya School of Medicine, Central South University, Zhuzhou, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2024 Mar 7;19:683-693. doi: 10.2147/COPD.S447905. eCollection 2024.
Carbapenem-resistant (CRKP) is closely related to respiratory tract infection. The aim of this study was to investigate the clinical features and prognostic factors of CRKP-induced pneumonia in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.
A single-centre, retrospective case-control study on COPD patients hospitalized for acute exacerbation and CRKP-induced pneumonia was conducted from January 1, 2016, to December 31, 2022. The mortality rate of acute exacerbation due to CRKP-induced pneumonia was investigated. The patients were divided into the CRKP-induced pneumonic acute exacerbation (CRKPpAE) group and the non-CRKP-induced pneumonic acute exacerbation (non-CRKPpAE) group, and the clinical characteristics and prognostic factors were compared using univariate analysis and multivariate analysis.
A total of 65 AECOPD patients were included, composed of 26 patients with CRKPpAE and 39 patients with non-CRKPpAE. The mortality rate of CRKPpAE was 57.69%, while non-CRKPpAE was 7.69%. Compared with non-CRKPpAE, a history of acute exacerbation in the last year (OR=8.860, 95% CI: 1.360-57.722, =0.023), ICU admission (OR=11.736, 95% CI: 2.112-65.207, =0.005), higher NLR levels (OR=1.187, 95% CI: 1.037-1.359, =0.013) and higher D-dimer levels (OR=1.385, 95% CI: 1.006-1.905, =0.046) were independently related with CRKPpAE. CRKP isolates were all MDR strains (26/26, 100%), and MDR strains were also observed in non-CRKP isolates (5/39, 12.82%).
Compared with non-CRKPpAE, CRKPpAE affects the COPD patient's condition more seriously and significantly increases the risk of death.
耐碳青霉烯类肺炎克雷伯菌（CRKP）与呼吸道感染密切相关。本研究旨在探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者中CRKP所致肺炎的临床特征及预后因素。
对2016年1月1日至2022年12月31日因急性加重住院且发生CRKP所致肺炎的慢性阻塞性肺疾病患者进行单中心回顾性病例对照研究。调查CRKP所致肺炎导致的急性加重死亡率。将患者分为CRKP所致肺炎急性加重（CRKPpAE）组和非CRKP所致肺炎急性加重（非CRKPpAE）组，采用单因素分析和多因素分析比较临床特征及预后因素。
共纳入65例AECOPD患者，其中CRKPpAE组26例，非CRKPpAE组39例。CRKPpAE组死亡率为57.69%，非CRKPpAE组为7.69%。与非CRKPpAE组相比，去年急性加重病史（OR=8.860，95%CI：1.360 - 57.722，P=0.023）、入住重症监护病房（ICU）（OR=11.736，95%CI：2.112 - 65.207，P=0.005）、较高的中性粒细胞与淋巴细胞比值（NLR）水平（OR=1.187，95%CI：1.037 - 1.359，P=0.013）和较高的D - 二聚体水平（OR=1.385，95%CI：1.006 - 1.905，P=0.046）与CRKPpAE独立相关。CRKP分离株均为多重耐药菌株（26/26，100%），非CRKP分离株中也观察到多重耐药菌株（5/39，12.82%）。
与非CRKPpAE相比，CRKPpAE对慢性阻塞性肺疾病患者病情影响更严重，显著增加死亡风险。
