Retrospektivna kohortna studija preživljavanja bolesnika sa bolničkom infekcijom izazvanom bakterijom Klebsiella pneumoniae – klinički, fenotipski i genotipski prediktori u tercijarnoj zdravstvenoj ustanovi u Srbiji (2022–2023)
Sažetak
Uvod/Cilj. Klebsiella (K.) pneumoniae je čest uzročnik bolničkih infekcija (healthcare-associated infections – HAI), naročito u jedinicama intenzivne nege. Karbapenem-rezistentni sojevi predstavljaju ozbiljnu pretnju zbog visoke smrtnosti i ograničenih terapijskih mogućnosti. Cilj rada bio je da se identifikuju klinički prediktori 30-dnevne smrtnosti i da se utvrdi prisustvo gena za karbapenemaze kod izolata K. pneumoniae. Metode. Retrospektivna kohortna studija sprovedena je na Vojnomedicinskoj akademiji u Beogradu, Srbija. Studija je obuhvatila 121 bolesnika sa HAI izazvanim K. Pneumoniae od januara 2022. do decembra 2023. godine. Klinički podaci prikupljeni su aktivnim nadzorom nad HAI. Izolacija i ispitivanje osetljivosti na antimikrobne lekove urađeni su standardnim mikrobiološkim procedurama, a detekcija gena za karbapenemaze urađena je metodom multipleks lančane reakcije polimeraze. Preživljavanje je analizirano Kaplan-Majerovom metodom, a prediktori smrtnosti Koksovom regresionom analizom. Rezultati. Tridesetodnevna smrtnost iznosila je 59,5%. Zabeležene su visoke stope rezistencije na aminoglikozide (84,3%), fluorohinolone (94,2%) i karbapeneme (95,9%), dok je 67,8% izolata bilo multirezistentno. Najčešći gen bio je blaOXA-48-like (45,5% u 2022. i 65,9% u 2023. godini), zatim blaNDM (22,7% u 2022. i 4,5% u 2023. godini), dok je blaKPC (23,9%) detektovan samo u 2023. godini. Najčešće otkrivena kombinacija gena za karbapenemaze bila je blaNDM + blaOXA-48-like (31,8% u 2022. i 5,7% u 2023. godini). Detektovani geni nisu imali značajan uticaj na preživljavanje. Starost ≥ 70 godina, infekcija krvotoka i boravak u jedinicama intenzivne nege identifikovani su kao nezavisni prediktori 30-dnevne smrtnosti. Zaključak. Visoka smrtnost kod bolesnika sa HAI izazvanom karbapenem-rezistentnim sojevima K. pneumoniae pre svega je bila povezana sa karakteristikama bolesnika i težinom osnovnog oboljenja, a ne sa prisustvom gena za karbapenemaze.
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