老年社区获得性肺炎患者感染克雷伯菌的临床特征和危险因素分析

严俊; 卞秀娟; 石宝平; 苏建花; 承璐潇; 陈自力; 唐云波; 洪雁; 丁莹

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微生物与感染 ›› 2024, Vol. 19 ›› Issue (4) : 211-218.

论著

老年社区获得性肺炎患者感染克雷伯菌的临床特征和危险因素分析

严俊,卞秀娟,石宝平,苏建花,承璐潇,陈自力,唐云波,洪雁,丁莹

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Clinical characteristics and risk factors analysis of Klebsiella pneunoniae infections in elderly patients with community-acquired pneumonia

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摘要

探讨老年患者感染肺炎克雷伯菌（Klebsiella pneunoniae）的临床特征、耐药类型及相关危险因素。收集2021-2023年上海市宝山区仁和医院收治的322例老年社区获得性肺炎（Community-acquired pneumonia，CAP）患者的诊疗数据，将患者分为肺炎克雷伯菌感染组（56例）和非肺炎克雷伯菌感染组（266例）。采用多因素Logistic回归分析识别患者感染肺炎克雷伯菌的危险因素。通过受试者工作特征曲线分析各指标评估患者感染肺炎克雷伯菌的临床价值。研究结果显示，肺炎克雷伯菌株对氨苄西林、头孢呋辛、头孢他啶和哌拉西林表现出较高的耐药率。多因素分析表明，男性、呼吸衰竭、影像学显示肺部实变影和空腹血糖水平高是肺炎克雷伯菌感染的独立危险因素。ROC曲线显示，男性、呼吸衰竭和空腹血糖水平高的评估感染风险的曲线下面积（AUC）均超过0.6，四个独立危险因素的联合指标的AUC达到0.762。感染肺炎克雷伯菌的老年CAP人群展现出特定的临床特征，并面临较高的耐药率。男性、空腹血糖高、呼吸衰竭和肺部有实变影为感染肺炎克雷伯菌的独立危险因素。因此，在临床实践中，因尽早识别并针对这些高风险人群实施有效的治疗和管理策略。

Abstract

To investigate the clinical characteristics, drug resistance types and risk factors of Klebsiella pneumoniae infection in elderly patients. The clinical data from 322 elderly patients with community-acquired pneumonia (CAP) who admitted to Renhe Hospital of Baoshan District Shanghai from 2021 to 2023 were collected, and the patients were divided into a Klebsiella pneumoniae-infected group (KP group, 56 patients) and a non-Klebsiella pneumoniae-infected group (NKP group, 266 patients). Multifactorial logistic regression analysis was used to identify risk factors and the receiver operating characteristic curve (ROC) was assessed to the clinical value of indicators for Klebsiella pneumoniae infection. The results showed that Klebsiella pneumoniae exhibited high rates of resistance to ampicillin, cefuroxime, ceftazidime and piperacillin. Multifactorial analysis showed that males, respiratory failure, solid shadows in the lungs, and high fasting glucose levels were independent risk factors for Klebsiella pneumoniae infection. ROC curve showed that the area under the curve (AUC) for assessing the risk of infection for males, respiratory failure, and high fasting glucose levels exceeded 0.6, and the AUC of the combined indicator of the four independent risk factors reached 0.762. The elderly CAP population with Klebsiella pneumoniae demonstrates specific clinical characteristics and faces a high rate of drug resistance. Being male, high fasting glucose, respiratory failure and having solid shadows in the lungs were independent risk factors for infection with Klebsiella pneumoniae. Therefore, early identification and implementation of effective treatment and management strategies for these high-risk groups is essential in clinical practice.

导出引用

严俊卞秀娟石宝平苏建花承璐潇陈自力唐云波洪雁丁莹. 老年社区获得性肺炎患者感染克雷伯菌的临床特征和危险因素分析[J]. 微生物与感染. 2024, 19(4): 211-218

Clinical characteristics and risk factors analysis of Klebsiella pneunoniae infections in elderly patients with community-acquired pneumonia[J]. Journal of Microbes and Infections. 2024, 19(4): 211-218

中图分类号： R441 R453

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