大肠埃希菌与肺炎克雷伯菌血流感染临床特征及抗菌治疗效果比较  

Clinical characteristics and antimicrobial treatment of Escherichia coli and Klebsiella pneumoniae bloodstream infection

作　　者：楼颂羔 王微 张建松[3] 黄小松[4] LOU Songgao;WANG Wei;ZHANG Jiansong(Department of Pharmacy,Shengzhou Hospital of Traditional Chinese Medicine,Shengzhou 312400,China)

机构地区：[1]嵊州市中医院药剂科,312400 [2]嵊州市中医院感染科,312400 [3]嵊州市中医院重症医学科,312400 [4]嵊州市中医院泌尿外科,312400

出　　处：《浙江医学》2020年第5期458-461,共4页Zhejiang Medical Journal

摘　　要：目的比较大肠埃希菌与肺炎克雷伯菌血流感染的临床特征及抗菌治疗效果,为临床诊治及抗菌药物合理使用提供参考。方法选取大肠埃希菌血流感染成年患者62例(大肠埃希菌组),肺炎克雷伯菌血流感染成年患者44例(肺炎克雷伯菌组)。比较两组患者临床特征、耐药率、抗菌治疗方案及临床转归等信息。结果肺炎克雷伯菌组男性患者比例、血流感染发生时序贯性器官功能衰竭评分、腹腔感染比例、迁移灶比例、白细胞计数均高于大肠埃希菌组,泌尿道感染比例低于大肠埃希菌组,差异均有统计学意义(均P<0.05)。肺炎克雷伯菌组对阿米卡星、哌拉西林/他唑巴坦的耐药率高于大肠埃希菌组,对氨曲南、头孢曲松、头孢唑啉的耐药率则低于大肠埃希菌组,差异均有统计学意义(均P<0.05)。肺炎克雷伯菌组产超广谱β-内酰胺酶菌株比例低于大肠埃希菌组,差异有统计学意义(P<0.05)。肺炎克雷伯菌组初始联合治疗比例高于大肠埃希菌组,差异有统计学意义(P<0.01)。肺炎克雷伯菌组治疗无效率高于大肠埃希菌组,治愈率低于大肠埃希菌组,差异均有统计学意义(均P<0.05)。结论大肠埃希菌与肺炎克雷伯菌血流感染在临床特征、耐药性及临床转归上存在差异;肺炎克雷伯菌迁移性更强,治疗具有复杂性。临床应加强抗菌药物的合理使用,重视感染综合防控措施的运用。Objective To investigate the clinical characteristics and antimicrobial treatment of Escherichia coli(E.coli)and Klebsiella pneumonia(K.pneumonia)bloodstream infection(BSI).Methods A total of 106 adult patients with BSI due to E.coli or K.pneumonia were enrolled,including 62 cases of E.coli BSI(E.coli group)and 44 cases of K.pneumonia BSI(K.pneumonia group).The clinical characteristics,drug resistance rates,antibacterial treatment and clinical outcome of the two groups were compared.Results The proportion of male patients and migratory lesions in K.pneumoniae group was higher than that in E.coli group(P<0.01).The most common source of infection in the E.coli group was urinary tract infection and intra-abdominal infection in the K.pneumoniae group.Compared with E.coli,the resistance rates to amikacin,piperacillin/tazobactam were higher in K.pneumoniae,while the resistance rates to amitracinam,ceftriaxone and cefazoline were lower(P<0.05).In K.pneumoniae group,the rate of extended-spectrumβ-lactamase-producing strains was lower than that in E.coli group(P<0.05).The proportion of initial combined treatment in K.pneumoniae group was higher than that in E.coli group(P<0.01).Compared with the E.coli group,the therapeutic in effectiveness was higher while the cure rate was lower in K.pneumonia group(P<0.05).Conclusion The clinical characteristics,drug resistance rate and clinical outcome are different between E.coli BSI and K.pneumoniae BSI.K.pneumoniae BSI is more migratory and treatment is complex.Rational use of antibiotics and comprehensive measures of infection prevention and 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 临床特征 抗菌治疗 

分 类 号：R515[医药卫生—内科学]