论文部分内容阅读
目的:探讨超广谱β-内酰胺酶(ESBL)肺炎克雷伯菌血源感染(Kp-BSIs)的概括及病死率。方法:收集2011-06-2015-06我院收治的111例肺炎克雷伯菌血源感染患者资料,按ESBL阳性与阴性分组,单因素Logistic回归分析年龄、性别、基础疾病、侵袭性器械使用、细菌耐药等因素在2组间的差异,多因素Logistic回归分析Kp患者ESBL阳性的独立危险因素。结果:(1)ESBL阳性组病死率高于ESBL阴性组(P=0.015);(2)ESBL阳性组的住院时间、菌血症发生前住院时间等明显高于ESBL阴性组(P=0.029,P=0.013),ESBL阳性组接受胸腹腔引流管、中心静脉导管、导尿管等侵袭性器械使用的比例更高(P=0.009,P=0.037,P=0.014);(3)ESBL阳性组耐药率更高;(4)哌拉西林-他唑巴坦耐药(OR=5.618,P=0.057)和留置导尿管(OR=1.023,P<0.001)是Kp-BSIs患者产ESBL的独立危险因素;(5)生存曲线显示ESBL阳性组在BSI发生后的90d生存率明显低于ESBL阴性组。结论:ESBL阳性Kp患者病死率高,接受侵袭性器械使用比例高,耐药率高。留置导尿管和哌拉西林-他唑巴坦耐药为ESBL阳性的独立危险因素。
Objective: To investigate the generalization and mortality of extended-spectrum β-lactamase (ESBL) Klebsiella pneumoniae infection (Kp-BSIs). Methods: The data of 111 cases of Klebsiella pneumoniae infection from 2011-06-2015-06 in our hospital were collected. According to the ESBL positive and negative grouping, single factor Logistic regression analysis was used to analyze the age, sex, basic diseases and the use of invasive instruments , Bacterial resistance and other factors in the two groups of differences, multivariate Logistic regression analysis of Kp patients with ESBL-positive independent risk factors. Results: (1) The mortality of ESBL-positive group was higher than that of ESBL-negative group (P = 0.015). (2) The length of hospital stay and the duration of hospitalization before ESBL-positive were significantly higher than those of ESBL-negative group P = 0.013). ESBL-positive patients underwent more thoracic and abdominal drainage tubes, central venous catheters and urinary catheters (P = 0.009, P = 0.037, P = 0.014) (4) Piperacillin-tazobactam resistant (OR = 5.618, P = 0.057) and indwelling catheter (OR = 1.023, P <0.001) were ESBL-producing patients with Kp-BSIs Independent risk factors; (5) Survival curves showed that ESBL positive group 90d survival rate after BSI was significantly lower than ESBL negative group. Conclusion: The ESBL-positive Kp patients have high mortality rate, high proportion of invasive devices and high resistance rate. Indwelling catheters and piperacillin-tazobactam resistance were independent risk factors for ESBL-positive.