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中华实验和临床感染病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (06) : 698 -702. doi: 10.3877/cma.j.issn.2016.06.010

临床论著

住院患者肺炎克雷伯菌血流感染的临床特点与耐药分析
段园园1, 曹敬荣1,(), 闵嵘1, 张丽丽1, 赵琪彦1, 王育英1, 谢威1, 王培昌1   
  1. 1. 100053 北京,首都医科大学宣武医院检验科
  • 收稿日期:2015-12-16 出版日期:2016-12-15
  • 通信作者: 曹敬荣
  • 基金资助:
    首都医科大学宣武医院院级课题(No. 2014)

Clinical characteristics and antimicrobial resistance of bloodstream infections caused by Klebsiella pneumoniae in hospitalized patients

Yuanyuan Duan1, Jingrong Cao1,(), Rong Min1, Lili Zhang1, Qiyan Zhao1, Yuying Wang1, Wei Xie1, Peichang Wang1   

  1. 1. Department of Clinica Laboratory, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
  • Received:2015-12-16 Published:2016-12-15
  • Corresponding author: Jingrong Cao
引用本文:

段园园, 曹敬荣, 闵嵘, 张丽丽, 赵琪彦, 王育英, 谢威, 王培昌. 住院患者肺炎克雷伯菌血流感染的临床特点与耐药分析[J/OL]. 中华实验和临床感染病杂志(电子版), 2016, 10(06): 698-702.

Yuanyuan Duan, Jingrong Cao, Rong Min, Lili Zhang, Qiyan Zhao, Yuying Wang, Wei Xie, Peichang Wang. Clinical characteristics and antimicrobial resistance of bloodstream infections caused by Klebsiella pneumoniae in hospitalized patients[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2016, 10(06): 698-702.

目的

了解住院患者肺炎克雷伯菌血流感染的临床特点、预后及耐药情况,为临床经验性治疗提供依据。

方法

回顾性分析本院2011年1月至2015年1月收治的肺炎克雷伯菌血流感染者的临床资料、抗菌药物使用和实验室检查结果。细菌鉴定和药敏试验采用Vitek-2 Compact系统和配套鉴定及药敏卡,应用Whonet 5.6进行耐药分析。

结果

75例入组者主要分布科室为ICU、普外科、血液科和急诊内科,平均年龄63岁,合并多种基础疾病,其中以肺部感染(46.67%)、颅脑疾病(30.67%)、糖尿病(29.33%)、胆道疾病(18.67%)、低血红蛋白症(18.67%)、肾功能不全(14.67%)和实体器官肿瘤(13.33%)多见,发生脓毒血症、感染性休克患者15例(20.00%)。药敏试验结果显示,75株肺炎克雷伯菌产ESBLs占42.67%,对美罗培南、亚胺培南和厄他培南的耐药率分别为6.67%、10.67%和8.00%,对哌拉西林/他唑巴坦(16.00%)和阿米卡星(10.67%)耐药率较低(均< 20%)。入组患者病死率为25.33%,MDR组患者病死率(29.73%)高于非MDR组(21.05%)。感染性休克、入住ICU为患者死亡的独立危险因素(χ2 = 18.91、P = 0.025,χ2 = 6.63,P = 0.01)。

结论

肺炎克雷伯菌血流感染常合并多种基础疾病,且病死率高,碳青霉烯类耐药菌的出现应引起重视。

Objective

To investigate the clinical characteristics and antimicrobial resistance of bloodstream infections (BSI) caused by K. pneumoniae in hospitalized patients and to provide a reference for the clinical treatment of K. pneumoniae.

Methods

Clinical data, laboratory results and antibiotic resistance of K. pneumoniae isolated from patients with blood infection from January 2011 to January in 2015 were reviewed, retrospectively. The identification of isolates and antimicrobial susceptibility testing were done by Vitek-2 compact. The antimicrobial resistance were analyzed by Whonet 5.6 software.

Results

Total of 75 clinical isolates of K. pneumoniae were mainly distributed in the wards of ICU, departments of general surgery, hematology and emergency. BSI caused by K. pneumoniae tends to develop into serious complications, and the top complications were pulmonary infection (46.67%), cerebral diseases (30.67%), diabetes (29.33%), biliary tract diseases (18.67%), low hemoglobin (18.67%), kidney dysfunction (14.67%) and tumer (13.33%). There were 15 (20.00%) cases suffered from sepsis or septic shock. The isolated rate of ESBLs-producing K. pneumoniae was 42.67%, and the resistance rates to meropenem, imipenem and ertapenem were 6.67%, 10.67% and 8.00%, respectively. The resistance rates of K. pneumoniae to piperacillin/tazobactam (16.00%) and amikacin (10.67%) were less than 20%. The total mortality rate was 25.33%, and the mortality rate of patients in MDR group (29.73%) was higher than that of non-MDR group (21.05%). Septic shock and whether stay in the ICU were the risk factors for K. pneumoniae BSI patients (χ2= 18.91, 6.63; P = 0.025, 0.01).

Conclusions

K. pneumoniae BSI tend to develop into serious complications, the higher mortility and the emergence of carbapenems-resistant K. pneumoniae isolates should be emphasized to the clinic.

表1 75例入组患者合并的基础疾病
表2 75株肺炎克雷伯菌对19种抗菌药物的药敏试验结果
表3 肺炎克雷伯菌血流感染预后的单因素分析[例(%)]
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