产超广谱 β-内酰胺酶肺炎克雷伯菌血流感染的耐药性、危险因素及临床结局分析

摘要

本研究旨在分析107例肺炎克雷伯菌血流感染患者的临床资料,探讨产超广谱 β-内酰胺酶(extended-spectrum β-lactamase,ESBL)肺炎克雷伯菌血流感染的耐药特点、危险因素及临床结局,为防治产ESBL肺炎克雷伯菌血流感染提供临床理论参考.选取2012年1月—2016年6月于深圳市南山区人民医院住院且血培养肺炎克雷伯菌阳性的107例患者,根据药敏结果分成产ESBL血流感染组(20例)和非产ESBL血流感染组(87例).107例患者血流感染主要继发于肺部感染(38.32%)及泌尿系感染(14.02%),细菌对碳青霉烯类抗生素敏感性好.单因素及logistic回归分析结果显示,医院内感染和入院前有外伤史为产ESBL肺炎克雷伯菌血流感染的危险因素.总体肺炎克雷伯菌血流感染病死率为17.76%,产 ESBL组与非产ESBL组之间病死率无显著性差异(25% vs.16.09%).结果提示,产ESBL不是预测肺炎克雷伯菌血流感染患者死亡的独立危险因素.%To analyze the bloodstream infection caused by extended-spectrum β-lactamase(ESBL)-producing Klebsiella pneumoniae(K.pneumoniae)in Shenzhen Nanshan District People's Hospital,and investigate the risk factors and antimicrobial resistance characteristics of such infections,107 cases with bloodstream infection caused by K.pneumoniae between January 2012 to September 2016 were selected for this study.According to the results of drug susceptibility testing,the patients were divided into the ESBL group(20 cases)and the non-ESBL group(87 cases).SPSS 19.0 software was used to analyze the data.Two of the leading causes for K.pneumoniae bloodstream infection were secondary infection by pulmonary(38.32%) and urinary tract(14.02%)respectively.Univariate analysis and logistic regression analysis confirmed that trauma and nosocomial infection were the risk factors of bloodstream infection caused by ESBL-producing K.pneumoniae.Antibiotic resistance in the ESBL group was significantly higher than the non-ESBL group. The isolates were sensitive to carbapenems.The mortality rate for all patients was 17.76%:25%(5 of 20) for the ESBL group and 16.09%(14 of 87)for the non-ESBL group respectively.The results indicated that ESBL production is not the independent factor of mortality of K.pneumoniae bloodstream infection.