呼吸机相关性肺炎死亡与高黏液表型肺炎克雷伯菌感染相关性巢式病例对照研究
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摘要
目的:探讨呼吸机相关性肺炎(ventilator associated pneumonia,VAP)死亡与高黏液表型肺炎克雷伯菌感染的相关性。方法:选取2014-02-01～2018-06-30入住重症监护病房(ICU)接受机械通气发生肺炎克雷伯菌感染的VAP患者1 328例为研究对象,用纤维支气管镜采集其深部痰标本进行细菌培养及药敏试验,深部痰标本中分离出高黏液表型肺炎克雷伯菌感染患者107例为观察组,非高黏液表型肺炎克雷伯菌患者中642例为对照组,采用回顾巢式病例对照研究设计,用多因素Logistic回归模型分析比较高黏液表型肺炎克雷伯菌感染与VAP死亡的相关性。结果:两组入住ICU时间与总住院时间比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,高黏液表型肺炎克雷伯菌感染是VAP死亡的高危因素(OR=2.500,95%CI:1.366～4.574)。观察组VAP死亡患者抗菌药物使用时间长于存活患者(P<0.05)。结论:VAP高黏液表型肺炎克雷伯菌感染已成为临床严重问题,一旦感染将会显著增加患者病死率。
Objective:To evaluate the correlation between ventilator associated pneumonia(VAP)death and Klebsiella pneumoniae infection in high mucus phenotype.Methods:A total of1 328 patients who received mechanical ventilation for Klebsiella.pneumoniae infection were included in intensive care unit(ICU)from February 2014 to June 2018.Deep sputum specimens were collected by fiberoptic bronchoscopy for bacterial culture and drug sensitivity test,107 cases of high mucus phenotype klebsiella pneumoniae infection were selected as observation group and 642 cases of non-hyperviscous phenotype klebsiella pneumoniae infection were selected as control group.A retrospective nested case-control study design was used to compare the difference in VAP death between the high mucus phenotype Klebsiella pneumoniae infection.Results:There were statistically significant difference in total hospital stay and length of stay in ICU between the two groups(P <0.05).Logistic analysis showed high mucus phenotypes of Klebsiella pneumoniae was the higher risk factor for VAP death(OR=2.500,95%CI:1.366-4.574).Died patients in the observation group received antibiotrci time was longer than those who survived(P <0.05).Conclusion:VAP with Klebsiella pneumoniae infection in high mucus phenotype has become serious problem in clinic,which can significantly increase the incidence of death.
Objective:To evaluate the correlation between ventilator associated pneumonia(VAP)death and Klebsiella pneumoniae infection in high mucus phenotype.Methods:A total of1 328 patients who received mechanical ventilation for Klebsiella.pneumoniae infection were included in intensive care unit(ICU)from February 2014 to June 2018.Deep sputum specimens were collected by fiberoptic bronchoscopy for bacterial culture and drug sensitivity test,107 cases of high mucus phenotype klebsiella pneumoniae infection were selected as observation group and 642 cases of non-hyperviscous phenotype klebsiella pneumoniae infection were selected as control group.A retrospective nested case-control study design was used to compare the difference in VAP death between the high mucus phenotype Klebsiella pneumoniae infection.Results:There were statistically significant difference in total hospital stay and length of stay in ICU between the two groups(P <0.05).Logistic analysis showed high mucus phenotypes of Klebsiella pneumoniae was the higher risk factor for VAP death(OR=2.500,95%CI:1.366-4.574).Died patients in the observation group received antibiotrci time was longer than those who survived(P <0.05).Conclusion:VAP with Klebsiella pneumoniae infection in high mucus phenotype has become serious problem in clinic,which can significantly increase the incidence of death.
引文
[1]刘卫平,孙德俊,闫志刚,等.呼吸机相关性肺炎危险因素分析[J].中华医院感染学杂志,2017,27(1):85-87.
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[3]Tsioutis C,Kritsotakis E I,Karageorgos S A,et al.Clinical epidemiology,treatment and prognostic factors of extensively drug-resistant Acinetobacter baumannii ventilator-associated pneumonia in critically ill patients[J].Int J Antimicrob Agents,2016,48(5):492-497.
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[5]罗甫花,姜维,蒋晓军,等.黏液型肺炎克雷伯菌耐药性[J].中国感染控制杂志,2015,15(5):314-316.
[6]中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南(草案)[J].中华结核和呼吸杂志,1999,22(4):201-203.
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[8]冯阳,唐忠平,聂丹阳,等.重症医学科呼吸机相关性肺炎的危险因素及病原学特点分析[J].西北国防医学杂志,2018,39(4):254-258.
[9]熊维,廖浩,吴颖,等.软毛牙刷刷牙预防重症监护室老年患者呼吸机相关肺炎的效果研究[J].西北国防医学杂志,2017,38(6):390-392.
[10]赵云,姜东亮,于法明.呼吸机相关性肺炎临床分析[J].河南医学研究,2017,26(1):45-46.
[11]LI W,Sun G,Yu Y,et al.Increasing occurrence of antimicrobial-resistant hypervirulent(hypermucoviscous)Klebsiella pneumoniae isolates in China[J].Clin Infect Dis,2014,58(2):225-232.
[12]周薇,黄文芳.高毒力肺炎克雷伯菌的研究进展[J].中国感染与化疗杂志,2016,16(6):800-803.
[13]Liu Y M,Li B B,Zhang Y Y,et al.Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China[J].Antimicrob Agents Chemother,2014,58(9):5379-5385.
[14]李桂立,孙运芳.临沂地区高毒力肺炎克雷伯菌的分子特征[J].医学检验与临床,2016,27(8):36-37.
[15]Russo T A,Shon A S,Beanan J M,et al.Hypervirulent K.pneumoniae secretes more and more active iron-acquisition molecules than"classical"klebsiella pneumoniae thereby enhancing its virulence[J].PLoS One,2011,6(10):26734.
[16]王靖,杨爱芝,赵应兰,等.2012~2014年某医院肺炎克雷伯菌耐药监测分析[J].中国消毒学杂志,2017,34(1):90-92.
[17]田李均,王晓丽,肖淑珍,等.医院内高黏液性肺炎克雷伯菌的流行分布、毒力基因及临床特征分析[J].上海交通大学学报(医学版),2017,37(1):43-48.
[18]马艳宁,张有江,郭玲,等.引起多部位感染的肺炎克雷伯菌毒力特征研究[J].中华医院感染学杂志,2016,26(21):4815-4834.
[19]Zhang Y,Zhao C,Wang Q,et al.High prevalence of hypervirulent Klebsiella pneumoniae infection in China:Geogra phicdistribution,clinical charact eristics and antimicrobial resistance[J].Antimicrob Agents Chemother,2016,60(10):6115-6120.
[2]Vincent J L,Rello J,Marshall J,et al.Intemational study of the prevalence and outcomes of infection in intensive care units[J].JSMA,2009,302(21):2323-2329.
[3]Tsioutis C,Kritsotakis E I,Karageorgos S A,et al.Clinical epidemiology,treatment and prognostic factors of extensively drug-resistant Acinetobacter baumannii ventilator-associated pneumonia in critically ill patients[J].Int J Antimicrob Agents,2016,48(5):492-497.
[4]Choi J Y,Kwak Y G,Yoo H,et al.Trends in the distribution and antimicrobial susceptibility of causative pathogens of device-associated infection in Korean intensive care units from 2006to 2013:results from the Korean nosocomial infections surveillance system(KONIS)[J].J Hosp Infect,2016,92(4):363-371.
[5]罗甫花,姜维,蒋晓军,等.黏液型肺炎克雷伯菌耐药性[J].中国感染控制杂志,2015,15(5):314-316.
[6]中华医学会呼吸病学分会.医院获得性肺炎诊断和治疗指南(草案)[J].中华结核和呼吸杂志,1999,22(4):201-203.
[7]沈勇,刘宝,翁云龙,等.ICU患者肺部感染真菌分析与耐药性研究[J].中华医院感染学杂志,2016,26(4):775-782.
[8]冯阳,唐忠平,聂丹阳,等.重症医学科呼吸机相关性肺炎的危险因素及病原学特点分析[J].西北国防医学杂志,2018,39(4):254-258.
[9]熊维,廖浩,吴颖,等.软毛牙刷刷牙预防重症监护室老年患者呼吸机相关肺炎的效果研究[J].西北国防医学杂志,2017,38(6):390-392.
[10]赵云,姜东亮,于法明.呼吸机相关性肺炎临床分析[J].河南医学研究,2017,26(1):45-46.
[11]LI W,Sun G,Yu Y,et al.Increasing occurrence of antimicrobial-resistant hypervirulent(hypermucoviscous)Klebsiella pneumoniae isolates in China[J].Clin Infect Dis,2014,58(2):225-232.
[12]周薇,黄文芳.高毒力肺炎克雷伯菌的研究进展[J].中国感染与化疗杂志,2016,16(6):800-803.
[13]Liu Y M,Li B B,Zhang Y Y,et al.Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China[J].Antimicrob Agents Chemother,2014,58(9):5379-5385.
[14]李桂立,孙运芳.临沂地区高毒力肺炎克雷伯菌的分子特征[J].医学检验与临床,2016,27(8):36-37.
[15]Russo T A,Shon A S,Beanan J M,et al.Hypervirulent K.pneumoniae secretes more and more active iron-acquisition molecules than"classical"klebsiella pneumoniae thereby enhancing its virulence[J].PLoS One,2011,6(10):26734.
[16]王靖,杨爱芝,赵应兰,等.2012~2014年某医院肺炎克雷伯菌耐药监测分析[J].中国消毒学杂志,2017,34(1):90-92.
[17]田李均,王晓丽,肖淑珍,等.医院内高黏液性肺炎克雷伯菌的流行分布、毒力基因及临床特征分析[J].上海交通大学学报(医学版),2017,37(1):43-48.
[18]马艳宁,张有江,郭玲,等.引起多部位感染的肺炎克雷伯菌毒力特征研究[J].中华医院感染学杂志,2016,26(21):4815-4834.
[19]Zhang Y,Zhao C,Wang Q,et al.High prevalence of hypervirulent Klebsiella pneumoniae infection in China:Geogra phicdistribution,clinical charact eristics and antimicrobial resistance[J].Antimicrob Agents Chemother,2016,60(10):6115-6120.