产超广谱β-内酰胺酶细菌脓毒血症31例危险因素及预后分析  

Risk factors and prognosis in 31 patients with extended-spectrum β-1actamase producing Escherichia coli and KlebsieUa pneumoniae bloodstream infection

作　　者：陈亚红[1] 姚婉贞[1] 伍蕊[1] 周庆涛[1] 刘振英[2] 张晓伟[2] 

机构地区：[1]北京大学第三医院呼吸科,100083 [2]北京大学第三医院细菌室,100083

出　　处：《中华结核和呼吸杂志》2008年第11期815-819,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的分析产超广谱β-内酰胺酶（ESBLs）大肠埃希菌和肺炎克雷白杆菌脓毒血症患者的高危因素、预后及细菌耐药性。方法回顾性分析北京大学第三医院自2004年1月至2005年12月细菌室分离的、血培养阳性的大肠埃希菌和肺炎克雷白杆菌感染患者的临床资料，病例组为产ESBLs菌脓毒血症患者，对照组为非产ESBLs菌脓毒血症患者。计量资料采用t检验或非参数检验，计数资料采用卡方检验，比较两组患者的危险因素、预后及细菌耐药性。结果（1）共分离出产ESBLs菌大肠埃希菌265株（265／748，35．4％），肺炎克雷白杆菌56株（56／266，21．1％）；病例组15例，男8例，女7例，年龄11～82岁，平均（54±20）岁；对照组16例，男5例，女11例，年龄7d至84岁，平均（54±20）岁。（2）两组患者感染灶均来源于呼吸道、腹腔及生殖道等，在体温、热型、呼吸频率、心率、有无休克、白细胞数、Pitt菌血症评分、急性生理和慢性健康状况评分（APACHEⅡ评分）等方面差异均无统计学意义。（3）在危险因素方面，两组患者在分离到病原菌前的住院时间、住重症监护室的天数、机械通气例数、机械通气时间、是否应用深静脉导管、糖皮质激素或免疫抑制剂、制酸剂、全胃肠外营养、贫血、低蛋白血症及使用导尿管及胃管、手术、既往住院史等差异均无统计学意义。分离到病原菌前14d使用第三代头孢菌素的例数，病例组9例（9／11），对照组3例（3／10），两组比较差异有统计学意义（X2=5．743，P〈0．05）。（4）病例组与对照组比较对多种抗生素的耐药发生率高，包括哌拉西林（9例和5例，）（X2=7．013，P〈0．01）、头孢吡肟（7例和0例，X2=7．467，P〈0．01）、头孢他啶（9例和1例，X2=11．317，P〈0．01）、头孢哌酮／舒巴坦（11例和2例，X2=11．780，P〈0．01）、左氧氟沙星�Objective To investigate the risk factors, prognosis and resistance to antibiotics in patients with extended-spectrum b-lactamase （ESBLs）-producing Escherichia coil and Klebsielta pneumoniae bloodstream infection. Methods A retrospective study was conducted in patients with Escherichia coli and KlebsieUa pneumoniae bloodstream infection isolated from Jan. 2004 to Dec. 2005 in Peking University Third Hospital. Those with ESBLs-producing sepsis were case patients, while non-ESBLs-producing sepsis were control patients. The unpaired Student＇ s t-test or non-parametric test and Chi-square test was used for comparison of risk factors, prognosis and resistance to antibiotics between the two groups. Results A total of 265 （265/748, 35.4% ） strains of ESBLs-producing Escherichia coli and 56 （56/266, 21.1% ）strains of Klebsiella pneumoniae were isolated between 2004 and 2005, respectively. There were 15 patients with ESBLs-producing sepsis （M/F： 8/7, age 11 -82 yr） and 16 with non-ESBLs-producing sepsis （M/F： 5/11, age 7 d - 84 yr）. The frequent origins of infection in the 2 groups were respiratory system, peritoneal cavity and reproductive system. No statistical difference was found between the 2 Stoups in clinical symptoms such as temperature, fever type, respiratory rate, heart rate, shock, white blood cells. Pitt bacteremia score and APACHE Ⅱ score （ all P 〉 0.05 ）. No statistical difference was found between the 2 groups in risk factors such as length of hospital stay before pathogen isolation, length of ICU stay, use of mechanical ventilation, duration of mechanical ventilation, use of central venous catheter, glucocorticosteroids or immunosuppressants, histamine-2-receptor agonists, urinary catheter, operation, gastric tube, total parenteral nutrition, previous hospital admission, anemia and hypoalbuminemia （ all P 〉 0.05）. However, the number of use of third-generation cephalosporin given 2 weeks before strains isolation was 9 in case patients （9/11） and 3 in control pat

关 键 词：大肠埃希菌 克雷白杆菌 肺炎 Β内酰胺酶类 危险因素 

分 类 号：R686[医药卫生—骨科学]