2018-2024年杭州市某三甲医院肺炎克雷伯菌血流感染患者死亡的风险因素分析OA

[Objective]To explore the 28-day mortality risk of Klebsiella pneumoniae(KP)bloodstream infections(BSI)and its related influencing factors,thereby providing a scientific basis for the effective control of KP-BSI and improvement of patient prognosis.[Methods]From January 2018 to December 2024,a retrospective review was conducted on hospitalized patients aged>18 years old treated for KP-BSI at a tertiary hospital in Hangzhou.Logistic and Cox regression analyses were performed to identify the epidemiological characteristics and the risk factors for the 28-day mortality associated with KP-BSI.[Results]A total of 123 patients with KP-BSI were included in this study,comprising 64 cases infected with carbapenem-resistant Klebsiella pneumoniae(CRKP)and 59 cases infected with carbapenem-susceptible Klebsiella pneumoniae(CSKP).Compared with CSKP-BSI,patients with CRKP-BSI more frequently presented with chronic pulmonary disease(χ²=4.29,P=0.038),concomitant infections at other sites(χ²=10.90,P=0.001),and a higher frequency of invasive procedures prior to infection(central venous catheterization,mechanical ventilation,and indwelling urinary catheter),as well as glucocorticoid use,hemodialysis,and blood transfusion(all P<0.05).The 28-day mortality was significantly higher in BSI cases caused by CRKP compared to that caused by CSKP(37.50%vs 5.08%,P<0.001).Cox regression analyses revealed that carbapenem resistance(HR=6.67,95%CI:1.48 - 30.08,P=0.014)and blood transfusion(HR=3.58,95%CI:1.15 - 11.19,P=0.028)were risk factors for the 28-day mortality in KP-BSI,while removal of central venous catheters after infection(HR=0.24,95%CI:0.08-0.67,P=0.006)was associated with a reduced risk for the 28-day mortality.[Conclusion]Carbapenem resistance is associated with mortality outcomes in patients with KP-BSI.Strengthening infection control measures targeting the identified risk factors for CRKP-BSI may improve patient prognosis.