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耐碳青霉烯类药物引起的血流感染:危险因素、治疗反应及死亡率分析

Bloodstream infections caused by carbapenem-resistant : analysis of risk factors, treatment responses and mortality.

作者信息

Şimşek Bozok Tuğçe, Bozok Taylan, Şahinoğlu Mustafa Serhat, Kaya Hamide, Horasan Elif Şahin, Kaya Ali

机构信息

Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Mersin University, Mersin, Türkiye.

Department of Medical Microbiology, Faculty of Medicine, Mersin University, Mersin, Türkiye.

出版信息

Infect Dis (Lond). 2025 Apr;57(4):350-360. doi: 10.1080/23744235.2024.2436991. Epub 2024 Dec 11.

Abstract

OBJECTIVE

Bloodstream infections (BSIs) caused by carbapenem-resistant (CRKP) are a serious threat to public health. In this study, it was aimed to evaluate the risk factors, treatment, length of hospitalisation and mortality of patients with BSI caused by CRKP.

METHODS

Between October 2021 and October 2023, patients aged 18 years and older who were treated for BSI at Mersin University Faculty of Medicine Hospital and had pathogens identified as CRKP or carbapenem-sensitive (CSKP) were retrospectively reviewed and included in the study.

RESULTS

Of the 107 patients with BSI included in the study, 66 (61.7%) had CRKP and 41 (38.3%) had CSKP. The risk factors associated with CRKP in BSIs were found to be acute renal failure (, mechanical ventilation (MV) , post-earthquake period and use of carbapenem and other beta-lactam antibiotics . Mortality was significantly higher in BSIs caused by CRKP (80.3%/29.3%, ). In the CRKP group, intensive care unit follow-up (), intubation (), MV monitoring () and concomitant pneumonia () significantly increased mortality. There were no significant differences in treatment outcomes between ceftazidime-avibactam and carbapenem combinations (). In the CRKP group, the duration of treatment and hospital stay were significantly longer in patients who started treatment three days or later ().

CONCLUSION

This study demonstrates that identifying risk factors for BSIs caused by CRKP and implementing early treatment protocols may lead to a reduction in treatment time and mortality rate.

摘要

目的

耐碳青霉烯类肺炎克雷伯菌(CRKP)引起的血流感染(BSIs)对公共卫生构成严重威胁。本研究旨在评估CRKP引起的BSIs患者的危险因素、治疗、住院时间和死亡率。

方法

回顾性分析2021年10月至2023年10月在梅尔辛大学医学院医院接受BSIs治疗且病原体鉴定为CRKP或碳青霉烯类敏感肺炎克雷伯菌(CSKP)的18岁及以上患者,并将其纳入研究。

结果

本研究纳入的107例BSIs患者中,66例(61.7%)为CRKP,41例(38.3%)为CSKP。发现BSIs中与CRKP相关的危险因素为急性肾衰竭()、机械通气(MV)()、震后时期()以及碳青霉烯类和其他β-内酰胺类抗生素的使用()。CRKP引起的BSIs死亡率显著更高(80.3%/29.3%,)。在CRKP组中,重症监护病房随访()、插管()、MV监测()和合并肺炎()显著增加死亡率。头孢他啶-阿维巴坦与碳青霉烯类联合用药的治疗效果无显著差异()。在CRKP组中,治疗开始三天或更晚的患者治疗时间和住院时间显著更长()。

结论

本研究表明,识别CRKP引起的BSIs的危险因素并实施早期治疗方案可能会缩短治疗时间并降低死亡率。

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