不同病原菌致血流感染相关急性肾损伤的危险因素分析

目的:研究不同病原菌所致血流感染患者中急性肾损伤(acute kidney injury,AKI)的发生率、危险因素和预后.方法:2018年1月1日至12月31日我院血流感染患者,选取最常见的4种病原体肺炎克雷伯菌、大肠埃希菌、凝固酶阴性葡萄球菌和金黄色葡萄球菌共计348例患者纳入本研究.收集患者基本资料、住院期间生化...

Risk factors of acute kidney injury in the patients with bloodstream infection caused by different pathogens

Objective To investigate the incidence,risk factors and prognosis of acute kidney injury(AKI)in the patients with bloodstream infection caused by different pathogens.Methods From January 1,2018 to December 31,2018,the patients with blood stream infection in our hospital were enrolled and four most common pathogens including Klebsiella pneumoniae,Escherichia coli,coagulase-negative Staphylococcus and Staphylococcus aureus were tested and total 348 patients were included in this study.The basic information,biochemical indicators during hospitalization and the time and type of invasive procedures before positive blood culture of patients were collected.In accordance with Kidney Disease:Improving Global Outcomes(KDIGO)AKI diagnostic criteria,the definition of AKI was an creatinine increase≥26.5μmol/L within 48 h or an 1.5 time increase than the baseline creatinine level within 1 week.The Logistic regression analysis was used to analyze the risk factors,incidence,and prognosis of AKI in the patients with bloodstream infection caused by different pathogens.Results A total of 348 patients with positive blood culture were included in this study.Among them,70 patients(20.1%)developed AKI.The incidence of AKI was 23.3%,22.2%,22%and 15.1%in the patients infected with Staphylococcus aureus,coagulase negative Staphylococcus,Klebsiella pneumoniae and Escherichia coli,respectively.The basic creatinine in the patients with AKI was(80.01±37.09)μmol/L,which was significantly higher than that in the cases without AKI[(69.98±46.40)μmol/L,P=0.008],and the patients in the AKI group received more invasive procedures(70.0%vs34.5%,P=0.001).Multivariate Logistic regression analysis showed that the invasive procedures were risk factors for AKI patients with bloodstream infection caused by different pathogens[odds ratio(OR)=3.25,95%confidence interval(CI):1.80-5.89,P<0.001].The incidence of AKI(χ²=2.42,P=0.49),kidney function recovery(χ²=6.40,P=0.09)and mortality(χ²=2.40,P=0.49)in bloodstream infection caused by different pathogens didn’t show statistical difference.Conclusions The invasive procedures are risk factors for AKI in the patients with bloodstream infection caused by different pathogens.There is no statistical difference in the incidence and prognosis of AKI among the patients with bloodstream infection caused by different pathogens.