脓毒血症患者临床特征及其感染的肺炎克雷伯菌耐药机制分析  

Analysis of the clinical features of septicopyemia and the drug resistance of Klebsiella pneumoniae infecting patients

作　　者：陈小卫[1] 谢晓斌[2] CHEN Xiao-Wei;XIE Xiao-bin(Hematology,Guangzhou First People's Hospital,School of Medicine South China University of Technology,Guangzhou, China 510180;Guangzhou Medical University)

机构地区：[1]华南理工大学附属广州市第一人民医院,广东广州510180 [2]广州医科大学

出　　处：《中国病原生物学杂志》2019年第4期473-476,共4页Journal of Pathogen Biology

摘　　要：目的分析脓毒血症患者临床特征及其感染的肺炎克雷伯菌耐药机制,指导疾病治疗。方法收集74例脓毒血症患者及74例对照组患者临床资料,监测其IL-27、CRP、PCT临床指标水平。采用全自动鉴定仪分离鉴定病原菌,K-B法和结晶紫染色进行药敏试验及耐药机制分析,并进行统计学分析。结果 74例脓毒血症患者年龄、体温、白细胞计数以及APACHEⅡ评分水平分别为(46.86±13.26)岁、(38.64±0.91)℃、(12.82±4.11)×10~9/L、(24.11±4.86)分。对照组分别为(47.61±11.73)岁、(38.43±1.01)℃、(12.34±4.45)×10~9/L、(23.82±3.54)分,两组患者临床资料差异无统计学意义(P均>0.05)。脓毒血症患者IL-27、CRP、PCT水平分别为(3.07±0.74) ng/ml、(176.49±75.16) mg/L、(2.26±1.05) ng/ml,对照组分别为(2.39±0.72) ng/ml、(171.38±85.60) mg/L、(1.06±0.56) ng/ml;两组IL-27和PCT差异有统计学意义(P<0.05)。10例脓毒血症休克患者IL-27、CRP及PCT水平分别为(6.64±1.22) ng/ml、(131.92±62.50) mg/L、(5.18±0.88) ng/ml;64例非休克患者分别为(2.81±0.64) ng/ml、(165.06±80.60)mg/L、(1.89±0.95) ng/ml,两组IL-27和PCT差异有统计学意义(P<0.05)。分离41株病原菌,其中肺炎克雷伯菌11株、大肠埃希菌9株、凝固酶阴性葡萄球菌8株、金黄色葡萄球菌6株、假丝酵母菌4株、其他病原菌3株。肺炎克雷伯菌对头孢噻肟、头孢呋辛、环丙沙星、左氧氟沙星、亚胺培南的耐药率分别为45.45%、63.64%、27.27%、18.18%和9.09%。油镜下肺炎克雷伯菌耐药株菌体外部具有一层似雾状的生物膜。结论脓毒血症患者感染病原菌主要为肺炎克雷伯菌,生物膜形成可能是耐药的主要原因。临床感染导致的脓毒血症患者机体IL-27及PCT水平升高,脓毒血症休克患者升高更明显。Objective To analyze the clinical features of septicopyemia and the drug resistance of K.pneumoniae infecting patients in order to guide the treatment of that condition.Methods Clinical data on 74 patients with septicopyemia and 74 patients in the control group were collected to determine the levels of the clinical indices IL-27,CRP,and PCT.Pathogens were isolated and identified by an automated microbial identification system,drug sensitivity was analyzed using the K-B method,and mechanisms of drug resistance were analyzed using crystal violet staining.The results were statistically analyzed.Results The 74 patients with septicopyemia were 46.86±13.26 years of age and had a body temperature of 38.64±0.91℃,a white blood cell count of 12.82±4.11×10^9/L,and an APACHE II score of 24.11±4.86 points.The 74 patients in the control group were 47.61±11.73 years of age and had a body temperature of 38.43±1.01℃,a white blood cell count of 12.34±4.45×10^9/L,and an APACHE II score of 23.82±3.54 points.There were no significant differences in clinical data for the two groups.IL-27 was 3.07±0.74 ng/ml,CRP was 176.49±75.16 mg/L,and PCT was 2.26±1.05 ng/ml in the 74 patients with septicopyemia.IL-27 was 2.39±0.72 ng/ml,CRP was 171.38±85.60 mg/L,and PCT was 1.06±0.56 ng/ml in the 74 patients in the control group.The levels of IL-27 and PCT differed significantly between the two groups while the level of CRP did not.The severity of septicopyemia differed in the 74 patients:10 patients had septic shock while 64 did not.IL-27 was 6.64±1.22 ng/ml,CRP was 131.92±62.50 mg/L,and PCT was 5.18±0.88 ng/ml in the 10 patients with septic shock.IL-27 was 2.81±0.64 ng/ml,CRP was 165.06±80.60 mg/L,and PCT was 1.89±0.95 ng/ml in the 64 patients without septic shock.IL-27 and PCT levels differed significantly between patients with septicopyemia and the control group,but the CRP level did not differ significantly.Forty-one strains of pathogens were isolated from the 74 patients with septicopyemia,including 11 strains of K.p

关 键 词：临床指标 脓毒血症 肺炎克雷伯菌 耐药性 

分 类 号：R378.996[医药卫生—病原生物学]