希腊重症监护病房患者中产金属β-内酰胺酶/肺炎克雷伯菌碳青霉烯酶的肺炎克雷伯菌引起的血流感染：感染的危险因素和耐药类型对结局的影响。

Bloodstream infections caused by metallo-β-lactamase/Klebsiella pneumoniae carbapenemase-producing K. pneumoniae among intensive care unit patients in Greece: risk factors for infection and impact of type of resistance on outcomes.

机构信息

Intensive Care Unit, Hippokration General Hospital, Thessaloniki, Greece.

出版信息

Infect Control Hosp Epidemiol. 2010 Dec;31(12):1250-6. doi: 10.1086/657135. Epub 2010 Oct 25.

DOI:10.1086/657135

PMID:20973725

Abstract

OBJECTIVE

To determine risk factors for bloodstream infections (BSIs) caused by Klebsiella pneumoniae producing metallo-β-lactamases (MBLs) or K. pneumoniae carbapenemases (KPCs), as well as risk factors for mortality associated with carbapenem-resistant K. pneumoniae, among intensive care unit (ICU) patients.

METHODS

Two case-control studies were conducted in a patient cohort with K. pneumoniae BSIs in an 8-bed ICU in a Greek hospital from January 1, 2007, through December 31, 2008. In study 1, patients with K. pneumoniae BSIs were allocated among 3 groups according to isolate susceptibility profile: (1) carbapenem-susceptible insolates (control group), (2) MBL-producing isolates, or (3) KPC-producing isolates. The MBL and KPC groups were compared with the control group to identify risk factors for development of K. pneumoniae BSI. In study 2, patients with K. pneumoniae BSIs who died were compared with survivors to identify risk factors for mortality.

RESULTS

Fifty-nine patients had K. pneumoniae BSIs (22 with carbapenem-susceptible isolates, 18 with MBL-producing isolates, and 19 with KPC-producing isolates). All KPC-producing isolates carried the bla(KPC-2) gene, and 17 of 18 MBL-producing isolates carried bla(VIM-1). Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.13 [95% confidence interval, 1.03-1.25]; [Formula: see text]) was independently associated with KPC-producing K. pneumoniae BSIs. Nine (41%) of 22 control patients, 8 (44%) of 18 MBL group patients, and 13 (68%) of 19 KPC group patients died in the ICU. Nine (41%) of 22 control patients, 10 (56%) of 18 MBL group patients, and 15 (79%) of 19 KPC group patients died in the hospital. Isolation of KPC-producing K. pneumoniae was an independent predictor of ICU death ([Formula: see text]) and in-hospital death ([Formula: see text]) but not infection-attributable death.

CONCLUSIONS

BSIs due to KPC-producing K. pneumoniae resulted in significantly increased mortality. The accurate and rapid detection of these pathogens is necessary for therapeutic considerations and for the implementation of infection control measures to contain them.

摘要

目的

确定产金属β-内酰胺酶（MBL）或产碳青霉烯酶（KPC）肺炎克雷伯菌血流感染（BSI）的危险因素，以及碳青霉烯类耐药肺炎克雷伯菌相关死亡率的危险因素，研究对象为重症监护病房（ICU）患者。

方法

2007 年 1 月 1 日至 2008 年 12 月 31 日，在希腊一家医院的 8 张病床的 ICU 中进行了两项病例对照研究，纳入了发生肺炎克雷伯菌 BSI 的患者队列。在研究 1 中，根据分离株药敏谱将肺炎克雷伯菌 BSI 患者分为 3 组：（1）碳青霉烯敏感分离株（对照组），（2）产 MBL 分离株，或（3）产 KPC 分离株。将 MBL 和 KPC 组与对照组进行比较，以确定产肺炎克雷伯菌 BSI 的危险因素。在研究 2 中，将发生肺炎克雷伯菌 BSI 并死亡的患者与幸存者进行比较，以确定死亡率的危险因素。

结果

59 例患者发生肺炎克雷伯菌 BSI（22 例为碳青霉烯敏感分离株，18 例为产 MBL 分离株，19 例为产 KPC 分离株）。所有产 KPC 的分离株均携带 bla（KPC-2）基因，18 株产 MBL 的分离株中有 17 株携带 bla（VIM-1）基因。急性生理学和慢性健康评估 II 评分（比值比，1.13[95%置信区间，1.03-1.25]；[公式：见正文]）与产 KPC 的肺炎克雷伯菌 BSI 独立相关。22 例对照组患者中 9 例（41%）、18 例 MBL 组患者中 8 例（44%）和 19 例 KPC 组患者中 13 例（68%）在 ICU 死亡。22 例对照组患者中 9 例（41%）、18 例 MBL 组患者中 10 例（56%）和 19 例 KPC 组患者中 15 例（79%）在医院死亡。产 KPC 的肺炎克雷伯菌的分离是 ICU 死亡（[公式：见正文]）和院内死亡（[公式：见正文]）的独立预测因子，但不是感染相关死亡的独立预测因子。