Analysis of risk factors for mortality in patients with bloodstream infection of <i>Carbapenem-resistant Klebsiella pneumonia</i>

Abstract

Abstract:

Objective:To evaluate the clinical characteristics and risk factors for mortality of bloodstream infections ofCarbapenem-resistant Klebsiella pneumonia(CRKP).MethodsThe electronic medical records of the patients with CRKP bloodstream infection in Ruijin hospital in Shanghai from January 2017 to June 2019 were reviewed and analyzed retrospectively. The patients were divided into survival group and death group according to the clinical endpoint of 30 d after infection, and their clinical characteristics and risk factors for mortality were analyzed.ResultsA total of 74 patients with CRKP bloodstream infection were enrolled, and the mortality rate was 55.4%. The independent risk factors for mortality within 30 d were acute physiology and chronic health evaluation (APACHE) Ⅱscore≥16.5 [odds ratio (OR)=1.118, 95% confidence interval(CI): 1.012-1.236,P=0.029], and septic shock(OR=1.52, 95% CI: 3.002-52.227,P=0.001).ConclusionsThe patients with CRKP bloodstream infection have a high mortality rate. The higher APACHEⅡ score is, the greater risk of mortality will be. For each additional point in the score, the risk of death increased 11.8%. The risk of death in the patients with septic shock is 12.52 times higher than that in higher than without septic shock.

Key words:Bloodstream infection,Carbapenem-resistantKlebsiella pneumoniae,Risk factors for mortality,Acute physiology and chronic health evaluation

CLC Number:

BIAN Xiujuan, BAO Zhiyao, CHEN Hong, CHENG Luxiao, SHI Baoping. Analysis of risk factors for mortality in patients with bloodstream infection ofCarbapenem-resistant Klebsiella pneumonia[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(01): 73-77.

Figures/Tables4

变量	死亡组（n=41）	存活组（n=33）	统计值	P
年龄（岁）	56.9±19.5	52.5±17.2	F=0.99	0.316
男性[n（%）]	33（80.5）	24（72.7）	χ²=0.662	0.430
合并疾病[n（%）]
结构性肺病	3（7.3）	2（6.1）	χ²=0.046	0.831
心血管疾病	13（31.7）	5（15.2）	χ²=2.723	0.099
慢性肾脏疾病	10（24.4）	2（6.1）	χ²=4.521	0.033
糖尿病	11（26.8）	2（6.1）	χ²=5.446	0.020
脑血管疾病	6（14.6）	3（9.1）	χ²=0.135	0.713
血液系统疾病	8（19.5）	3（9.1）	χ²=0.854	0.356
3个月内手术[n（%）]	25（61.0）	24（72.7）	χ²=1.129	0.288
中心静脉置管[n（%）]	33（80.5）	28（84.8）	χ²=0.240	0.624
入住ICU[n（%）]	30（73.2）	21（63.6）	χ²=0.776	0.378
机械通气[n（%）]	34（82.9）	26（78.8）	χ²=0.204	0.651
VAP[n（%）]	32（78.0）	20（60.6）	χ²=2.663	0.103
早发	9（22.0）	11（33.3）	χ²=1.201	0.273
晚发	23（56.1）	9（27.3）	χ²=6.190	0.013
感染时指标
APACHE Ⅱ评分（分）	22.6±5.3	16.4±7.3	F=1.462	<0.001
降钙素原（μg/L）	28.2（6.4,58.2）	6.69（3.48,27.1）	U=472	0.026
CRP（mg/L）	226.0±93.6	224.1±75.3	F=0.416	0.926
高钠血症[n（%）]	30（73.2）	17（51.5）	χ²=3.700	0.054
感染性休克[n（%）]	38（92.7）	13（39.4）	χ²=24.239	<0.001
感染部位[n（%）]
下呼吸道	35（85.4）	28（84.8）	χ²=0.004	1.000
尿路	12（29.3）	8（24.2）	χ²=0.234	0.628
手术部位	18（43.9）	24（72.7）	χ²=6.190	0.013
深静脉导管	17（41.5）	20（60.6）	χ²=2.680	0.102
治疗>72 h[n（%）]	26（63.4）	33（100.0）	χ²=15.143	<0.001

变量	β	标准误	Wald	自由度	P	OR	95%CI
APACHEⅡ评分	0.112	0.051	4.773	1	0.029	1.118	1.012	1.236
感染性休克	2.527	0.729	12.029	1	0.001	12.52	3.002	52.227

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Analysis of risk factors for mortality in patients with bloodstream infection ofCarbapenem-resistant Klebsiella pneumonia

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