耐头孢他啶大肠埃希菌和肺炎克雷伯菌菌血症的危险因素及预后相关因素分析  

Analysis of the risk factors and prognosis of ceftazidimeresistant Escherichia coli and Klebsiella pneumoniae bacteremia

作　　者：隆云[1] 杜斌[1] 刘大为[1] 刘宏忠[2] 徐英春 谢秀丽 

机构地区：[1]中国医学科学院北京协和医院加强医疗科,北京100730 [2]北京邮电总医院,北京100032 [3]中国医学科学院北京协和医院细菌室,北京100730

出　　处：《中国危重病急救医学》2002年第8期485-488,共4页Chinese Critical Care Medicine

摘　　要：目的 :研究导致耐头孢他啶大肠埃希菌和肺炎克雷伯菌菌血症的危险因素 ,以及影响大肠埃希菌和肺炎克雷伯菌菌血症患者预后的相关因素。方法 :回顾性分析北京协和医院 1997— 2 0 0 0年的 85例患者的临床资料 ,记录大肠埃希菌及肺炎克雷伯菌菌血症患者初次血培养阳性时的基本状况 ,包括急性生理及慢性健康状况评分 (APACHE )、体征、基础疾病、免疫抑制治疗、实验室检查、有创操作及原发感染灶等 ,以及初次血培养结果、抗生素治疗、临床疗效及预后等方面情况。采用单因素分析及逻辑回归分析方法研究耐头孢他啶的大肠埃希菌和肺炎克雷伯菌菌血症的危险因素及预后。结果 :85例患者中 2 3例对头孢他啶耐药 ,占 2 7.1% ;近期使用头孢菌素 30例患者中 13例、近期使用第三代头孢菌素 2 5例患者中 12例出现耐头孢他啶大肠埃希菌或肺炎克雷伯菌菌血症 ;近期使用头孢菌素 (13/ 30 ,P=0 .0 13) ,尤其是第三代头孢菌素 (12 / 2 5 ,P=0 .0 0 5 )是影响耐头孢他啶大肠埃希菌或肺炎克雷伯菌菌血症的危险因素 ;2 3例上述耐药菌菌血症中仅有 3例死亡 ,耐药菌菌血症不增加患者病死率 (3/ 2 3,P=0 .16 4 ) ;14例不适当抗生素治疗患者中 7例死亡 ,不适当抗生素治疗(7/ 14 ,P=0 .0 16 )能增加患者的病死率。结论 :第三代头孢?Objective:To investigate the risk factors of ceftazidimeresistant Escherichia coli and Klebsiella pneumoniae bacteremia and the risk factors affecting prognosis of bacteremia.Methods:Eightyfive patients of Escherichia coli and Klebsiella pneumoniae bacteremia in Peking Union medical college hospital were studied retrospectively.The clinical characteristics of initial bacteremia,including age,acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) scores,signs,comorbid illness,immunosuppressive therapy,laboratory findings,invasive procedure,primary infectious focus, et al ,and results of initial blood culture,antibiotic treatments,clinical effect,and outcome were recorded.The relationship among the above risk factors and ceftazidimeresistant Escherichia coli and Klebsiella pneumoniae bacteremia and prognosis of bacteremia were analyzed with univariate analysis and Logistic regression.Results:Among 85 patients,there were 23 (27 1%) patients with ceftazidimeresistant bacteremia.Previous administration of cephalosporins(13/30, P =0 013),especially third gemeration cephalosporins(12/25, P =0 005) was more likely associated with ceftazidimeresistant bacteremia.The emergence of ceftazidimeresistance of the invading bacteria(3/23, P =0 164)was not associated with a higher mortality.Inappropriate antibiotic therapy(7/14, P =0 016) was associated with a higher mortality.Conclusions:Prior use of third generation cephalosporins was a risk factor of ceftazidimeresistant bacteremia. Inappropriate antibiotic therapy was associated with a higher mortality.However the emergence of ceftazidimeresistance of the invading bacteria was not associated with a higher mortality if an appropriated antibiotic was administered for treatment.

关 键 词：危险因素 预后 耐头孢他啶菌菌血症 大肠埃希菌 肺炎克雷伯菌 抗生素 治疗 超广谱内酰胺酶 头孢菌素酶 

分 类 号：R181.3[医药卫生—流行病学]