耐碳青霉烯类肺炎克雷伯菌血流感染患者<b>30 d</b>及以内死亡的相关因素分析

朱秋丽; 耿苗苗; 卫菊; 沈芸; 胡丹; 陈春霞; 陈海威; 孙喆

doi:10.19428/j.cnki.sjpm.2025.24815

耐碳青霉烯类肺炎克雷伯菌血流感染患者30 d及以内死亡的相关因素分析

An analysis of risk factors for mortality in patients with bloodstream infections caused by carbapenem-resistant Klebsiellapneumoniae

摘要

摘要:
目的分析上海市某三甲医院2016—2023年发生耐碳青霉烯类肺炎克雷伯菌（CRKP）血流感染（BSI）住院患者的临床特征，探索CRKP⁃BSI患者住院感染30 d及以内死亡（简称：≤30 d死亡）的相关因素。
方法回顾性收集2016年1月—2023年12月上海市某三甲医院住院患者的电子病历中的数据，指标包括年龄、性别、科室、手术治疗、经验性抗生素治疗、Pitt菌血症评分（PBS）、Charlson共病指数（CCI）、ICS评分（ICS）、住院天数、从CRKP⁃BSI到出院/死亡的时间等。对入院患者的随访时间截至出院，随访终点为住院期间死亡或出院。结局定义为住院患者因CRKP⁃BSI或感染相关并发症在≤30 d内（含30 d）发生死亡。患者在感染CRKP后30 d，存活的患者为生存组，死亡的患者为死亡组。通过Cox单因素回归和多因素回归，分析CRKP⁃BSI患者≤30 d死亡的相关因素。
结果研究期间共有71例住院患者发生CRKP⁃BSI，其中，男性51人，女性20人，年龄（ $\bar{x} \pm s$ ）为（65.12±18.25）岁，住院时间［M（P₂₅，P₇₅）］为37.00（24.00，56.00） d，从CRKP⁃BSI到出院/死亡时间为18.00（7.00，35.00） d。死亡组20人（28.17%），生存组51人（71.83%）。Cox多因素回归分析结果发现，ICS评分与CRKP⁃BSI患者发生≤30 d死亡正相关（HR=1.379，95%CI为1.137~1.671，P=0.001）；ICS评分每升高1分，患者发生≤30 d死亡风险增加37.9%。
结论 ICS评分可能是CRKP⁃BSI患者发生≤30 d死亡的相关危险因素，这有助于临床医生预测CRKP⁃BSI患者在30 d内发生死亡的风险，辅助临床决策。

Abstract:
Objective To explore the clinical characteristics and risk factors for 30-day mortality in hospitalized patients with bloodstream infections (BSI) caused by carbapenem-resistant Klebsiellapneumoniae (CRKP).
Methods Data were obtained retrospectively from the electronic medical records of inpatients at a tertiary A-grade hospital in Shanghai from January 2016 to December 2023. The collected variables included age, gender, department, surgical treatment, empirical antibiotic therapy, Pitt Bacteremia score (PBS), Charlson comorbidity index (CCI), INCREMENT-CPE score (ICS), length of hospital stay, the time from CRKP-BSI to discharge and, etc. The follow-up period ended upon discharge, with the follow-up outcomes defined as in-hospital mortality or discharge. The endpoint was defined as death within 30 days (including day 30) caused by CRKP-BSI or infection-related complications. Patients who survived within 30 days after CRKP-BSI were classified into the survival group, while those who died within 30 days were classified into the death group. Independent risk factors for 30-day mortality in patients with CRKP-BSI were analyzed using univariate and multivariate Cox regression analysis.
Results A total of 71 hospitalized patients with CRKP-BSI, comprising 51 males and 20 females, with an average age of (65.12±18.25) years, were included during the study period. The M (P₂₅, P₇₅) of hospital stay were 37.00 (24.00, 56.00) days, and M (P₂₅, P₇₅) of the duration from CRKP-BSI to discharge or death were 18.00 (7.00, 35.00) days. There were 20 deaths (28.17%) in the death group and 51 survivors (71.83%) in the survival group. The results of multivariate Cox regression analysis showed that the ICS as an independent risk factor for 30-day mortality in CRKP-BSI patients (HR=1.379, 95%CI: 1.137‒1.671, P=0.001). Each 1-point increase in the ICS was associated with a 37.9% increase in the risk of mortality.
Conclusion The ICS is found to be a risk factor for 30-day mortality in patients with CRKP-BSI, which may facilitate the prediction for the risk of 30-day mortality and thereby support clinical decision-making for patients with CRKP-BSI.

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