肺炎克雷伯菌血流感染151例临床特征及预后分析

目的 探讨肺炎克雷伯菌(Klebsiella pneumoniae, KP)血流感染(blood stream infections, BSI)的临床特征和影响预后的危险因素。方法 回顾性分析2014年1月—2018年12月间某三级医院确诊的KPBSI病例，分析其临床资料，应用多因素Logistic回归分析其90d死亡及预后不良的危险因素。结果 5年间共收集1672例血培养阳性病例，其中151例为KPBSI，90d死亡47例(31.1%)。Logistic多因素回归分析显示死亡的危险因素为医院感染(OR=4.86，95%CI：1.666~14.191，P=0.004)、CRKP感染(OR=5.42，95%CI：1.757~15.103，P=0.003)和入住ICU(OR=4.30，95%CI：1.695~10.908，P=0.002)。Logistic多因素回归分析显示预后不良的危险因素为医院感染(OR=4.70，95%CI：1.626~13.582，P=0.004)、CRKP感染(OR=4.73，95%CI：1.699~13.738，P=0.003)和入住ICU(OR=3.75，95%CI：1.569~8.969，P=0.003)。结论 KPBSI病死率高，医院感染、CRKP感染和入住ICU可作为预测患者死亡和预后不良的独立危险因子。

Clinical features and prognostic factors of blood stream infections caused by Klebsiella pneumoniae: A report of 151 cases

Objective To investigate the clinical features and prognostic factors of patients with Klebsiella pneumoniae bloodstream infection (KPBSI). Methods A retrospective study was carried out on KPBSI in hospitalized patients who were treated in a tertiary hospital from Jan 2014 to Dec 2018. Stepwise logistic regression was used to analyze the predictors of poor outcome and 90-day mortality. Results A total of 151 cases of KPBSI were identified from 1,672 positive blood cultures during the 5-year period. The 90-day mortality rate was 31.1% (47/151). Multivariate logistic regression analysis showed that the risk factors predicting death were nosocomial infections(OR=4.86, 95%CI: 1.666~14.191, P=0.004), CRKP infections(OR=5.42, 95%CI: 1.757~15.103, P=0.003), and ICU admission(OR=4.30, 95%CI: 1.695~10.908, P=0.002). Prognostic factors for poor outcome were nosocomial infections(OR=4.70, 95%CI: 1.626~13.582, P=0.004), CRKP infections(OR=4.73, 95%CI: 1.699~13.738, P=0.003), and ICU admission(OR=3.75, 95%CI: 1.569~8.969, P=0.003). Conclusion KPBSI is associated with high mortality. Nosocomial infections, CRKP infections, and ICU admission are independent risk factors predicting death and risk factors for poor outcome in patients with KPBSI.