耐碳青霉烯类肺炎克雷伯菌(CRKP)感染是全球公共卫生的主要威胁。为医院预防和控制CRKP感染,本研究分析了肺炎克雷伯菌CRKP感染和碳青霉烯类耐药的相关因素。本病例对照研究于2016年1月至2018年12月在中国一家大型综合医院进行,包括494例感染CRKP的住院患者(病例组1)和2429例感染碳青霉烯类易感肺炎克雷伯菌的住院患者(CSKP,病例组2)。我们从没有肺炎克雷伯菌感染的住院患者中选择对照组,病例对照比为1:3,采用条件logistic回归分析两个病例组的危险因素。多因素分析显示CRKP感染的危险因素为重症监护病房(ICU)入院(比值比[OR],6.85;95%置信区间[CI],4.90-9.58;P<0.001),呼吸衰竭(或,1.93;95%CI,1.34-2.77;P<0.001),年龄调整后的Charlson合并症指数(aCCI;OR,1.08;95%CI,1.02-1.15;P=0.007),急诊入院(或,1.37;95%CI,1.02-1.85;P=0.036),和亚胺培南使用(或,1.80;95%CI,1.30-2.49;P<0.001)。在上述五个危险因素中,aCCI(或,1.09;95%CI,1.06-1.13;P<0.001)在多变量分析中也被确定为CSKP感染的危险因素。肺炎克雷伯菌对碳青霉烯类抗生素耐药的危险因素为入住ICU,呼吸衰竭,从急诊入院,和亚胺培南的使用。
Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a major public health threat in the world. To inform the prevention and control of CRKP infection in hospitals, this study analyzed the factors associated with CRKP infection and resistance to carbapenems in K. pneumoniae. This
case-
case-control study was carried out in a large general hospital in China from January 2016 to December 2018, comprising 494 hospitalized patients infected with CRKP (
case group 1) and 2429 hospitalized patients infected with carbapenem-susceptible K. pneumoniae (CSKP,
case group 2). We selected control groups from hospitalized patients without K. pneumoniae infections for the two
case groups separately, with a 1:3
case-control ratio, to analyze the risk factors of the two
case groups using the conditional logistic regression. Multivariate analysis showed that the risk factors of CRKP infection were intensive care unit (ICU) admission (odds ratio [OR], 6.85; 95% confidence interval [CI], 4.90-9.58; P < 0.001), respiratory failure (OR, 1.93; 95% CI, 1.34-2.77; P < 0.001), age-adjusted Charlson comorbidity index (aCCI; OR, 1.08; 95% CI, 1.02-1.15; P = 0.007), admission from the Emergency (OR, 1.37; 95% CI, 1.02-1.85; P = 0.036), and imipenem use (OR, 1.80; 95% CI, 1.30-2.49; P < 0.001). Among the aforementioned five risk factors, aCCI (OR, 1.09; 95% CI, 1.06-1.13; P < 0.001) was also identified as a risk factor of CSKP infections in multivariate analysis. The risk factors for resistance to carbapenems in K. pneumoniae were ICU admission, respiratory failure, admission from the Emergency, and imipenem use.