大肠埃希菌与肺炎克雷伯菌血流感染的临床特征及耐药性比较  

Bloodstream infection caused by Escherichia coli versus Klebsiella pneumonia:Clinical characteristics and drug resistance

作　　者：王莉洁[1] 梁志欣[1] 喻航[1] 吴珍[1] 陈良安[1] 

机构地区：[1]解放军总医院呼吸内科,北京100853

出　　处：《解放军医学院学报》2017年第4期306-308,316,共4页Academic Journal of Chinese PLA Medical School

基　　金：部委级资助项目;军队"十二五"重点项目(BWS11J057)~~

摘　　要：目的探讨大肠埃希菌与肺炎克雷伯菌所致血流感染的临床特征和耐药性差异。方法回顾性分析2014年1月-2015年12月本院发生大肠埃希菌或肺炎克雷伯菌血流感染的住院患者的临床特征、产超广谱β内酰胺酶(extended spectrumβ-lactamase,ESBL)情况及药敏结果。结果共纳入血流感染患者436例,其中大肠埃希菌感染282例(64.7%),肺炎克雷伯菌感染154例(35.3%)。肺炎克雷伯菌感染患者死亡率(20.1%)高于大肠埃希菌感染死亡率(9.2%)(P=0.002)。大肠埃希菌最常见感染来源为胰胆系感染(30.1%)和泌尿道感染(20.2%),肺炎克雷伯菌最常见感染来源为肺部感染(37.7%)。产ESBL菌株检出率在大肠埃希菌和肺炎克雷伯菌血流感染患者中分别为56.8%和24.8%(P<0.001)。与肺炎克雷菌相比,大肠埃希菌对氟喹诺酮类药物耐药率较高,达63%~64.8%。总体耐碳青霉烯类肠杆菌科细菌占比为11%~12.9%,其中大肠埃希菌对亚胺培南和厄他培南耐药率分别为2.2%、2.9%,而肺炎克雷伯菌耐药率则高达26.8%~30.7%。两种细菌对阿米卡星的耐药率较低,为9.3%(4.4%~18.2%)。结论肺炎克雷伯菌和大肠埃希菌所致血流感染的临床特征和预后存在较大差异。肺炎克雷伯菌对碳青霉烯类耐药率高达26.6%~30.5%。应加强抗菌药物合理使用和医院感染控制。Objective To investigate the clinical characteristics and drug resistance in patients with bloodstream infection（BSI） due to K. pneumonia or E. coli. Methods We conducted a retrospective analysis on patients with BSI due to K. pneumoniae or E. coli from January 2013 to December 2015 in Chinese PLA General Hospital. Data were collected on underlying diseases,source of infection,production of extended spectrum β-lactamase（ESBL）,and drug sensitive test. Results Four hundred and thirtysix cases of BSI were enrolled in our study,with 282（64.7%） E. coli BSI and 154（35.3%） K. pneumoniae BSI. In-hospital 30-day mortality of patients were higher in K. pneumoniae（20.1%） than that in E. coli（9.2%）（P=0.002）. The most common sources of infection were pancreaticobiliary infection（30.1%） and urinary tract infection（20.2%） due to E.coli,and lung infection（37.7%） due to K. pneumoniae. ESBL was isolated from 56.8% of E. coli BSI and 24.8% of K. pneumoniae BSI,respectively（P〈0.001）. Compared with K. pneumoniae,the resistance rates to fluoroquinolone were higher in E. coli（63%-64.8%）. Carbapenem-resistant Enterobacteriaceae（CRE） strains accounted for an overall rate of 11%-12.9%,in which the resistance rates were up to 26.8%-30.7% for K. pneumoniae,and 2.2%-2.9% for E. coli. The resistance rate to amikacin（9.3%） was the lowest in the two strains.Conclusion The clinical characteristics and prognosis of BSI caused by E. coli and K. pneumoniae are significantly different. Both strains show high resistance rates to major antibiotics with Carbapenem-resistant rates of 26.8%-30.7% in K. pneumoniae. Rational use of antibiotics and hospital infection control should be strengthened in clinical practice.

关 键 词：大肠埃希菌 肺炎克雷伯菌 血流感染 耐药性 

分 类 号：R517.6[医药卫生—内科学] R516.1[医药卫生—临床医学]