关键词: 克雷伯菌感染, 碳青霉烯类耐药肺炎克雷伯菌, 感染, 死亡, 影响因素分析, 预测价值

Abstract: Background　Klebsiella pneumoniae is a common nosocomial infection pathogen，and carbapenem antibiotics is "the last line of defense" to treat its infection.In recent years，hospital infections caused by carbapenem-resistant Klebsiella pneumoniae（CRKP） are increasing due to the overuse of antibiotics，especially carbapenems.The detection rate of CRKP is also growing each year with the progress of medical technology.After infection，there are only a few sensitive antibiotics that can be selected clinically，yielding unoptimistic anti-infection effects，which in turn leads to a rising mortality rate.Objective　To identify the risk factors of mortality in patients of CRKP infection，and use them to establish a mortality risk prediction model，then evaluate the model's prognostic value.Methods　Clinical data of 199 patients with CRKP infection were collected from January 2017 to April 2019 from the Second Affiliated Hospital of Xi'an Jiaotong University，including 138〔modeling group consisting of 104 survivals and 34 deaths（classified at discharge）〕 receiving inpatient treatment from January 2017 to December 2018，and 61（validating group） from January to April 2019.General data，prevalence of underlying diseases，pre-hospital treatment，complications during hospitalization，invasive treatment，biochemical indices and temperature after 3-day initial treatment，post-admission treatment，and other indices were compared between the survival and death subgroups.Multivariate Logistic regression models were applied to investigate the risk factors of mortality in patients with CRKP infection，and based on the derived related coefficients，a mortality risk prediction model for CRKP infection was established，and ROC curve of the model was drawn to predict the mortality in modeling and validating group.Results　The mortality rate was 24.6%（34/138） in the modeling group and 24.6%（15/61） in the validating group.Multivariate Logistic regression analysis showed that multiple organ dysfunction syndrome during hospitalization，APACHE Ⅱ score ≥14 points after initial treatment，and use of vasoactive drugs were closely related to the mortality after CRKP infection（P<0.05）.The regression equation was that multiple organ dysfunction syndrome during hospitalization ×2.4 + （APACHE Ⅱ score ≥14 points after initial treatment）×1.5 + use of vasoactive drugs × 2.0.The mortality risk prediction model in CRKP infection was applied in modeling group with the value of H-L test 0.866，in validating group with 0.807.The area under the curve（AUC）of the model in modeling group was 0.851〔95%CI（0.774，0.928）〕，with optimal cut-off value of 2.75，sensitivity of 84.4%，specificity of 76.0% and Youden index of 0.584，and the AUC of which in validating group was 0.966〔95%CI（0.894，1.000）〕，with optimal cut-off value of 2.95，sensitivity of 100.0%，specificity of 87.0% and Youden index of 0.870.Conclusion　Multiple organ dysfunction syndrome during hospitalization，APACHE Ⅱ score ≥14 after initial treatment and use of vasoactive drugs are independent risk factors of mortality in CRKP infected patients.The mortality risk prediction model in CRKP infection fitted out based on the above-mentioned indices has a good prognostic value.

Key words: Klebsiella infections, Carbapenem-resistant Klebsiella pneumoniae, Infection, Mortality, Root cause analysis, Predictive value