摘要
目的探讨革兰阴性(G–)杆菌血流感染的临床及细菌学特点,为治疗G–杆菌血流感染提供指导。方法回顾性分析2015年1月至2017年12月北京安贞医院呼吸与危重症医学科收治的60例重症肺炎合并血流感染的患者临床资料,评价住院病死率及其危险因素。结果共纳入60例患者,其中男34例,女26例,平均年龄(73.4±11.2)岁。60例重症肺炎合并血流感染的患者中,感染肺炎克雷伯菌32例,鲍曼不动杆菌20例,大肠埃希菌8例。药敏结果显示:肺炎克雷伯菌对阿米卡星耐药率低(6.3%),未发现对替加环素耐药;大肠埃希菌对阿米卡星、亚胺培南、头孢他啶和美罗培南敏感性较好,对其他药物耐药;鲍曼不动杆菌的耐药率较高,其中对头孢哌酮/舒巴坦为28.6%(中介12.5%),对替加环素为14.3%(中介28.5%)。肺炎克雷伯菌和鲍曼不动杆菌两组患者感染指标及预后指标对比显示:鲍曼不动杆菌血流感染患者血清C反应蛋白、降钙素原及序贯器官功能障碍评分(SOFA)较高;肺炎克雷伯菌血流感染患者中性粒细胞和血乳酸水平较高;两组患者白细胞、血小板水平及死亡率差异无统计学意义。SOFA评分和血乳酸水平与患者预后具有显著相关性。结论 G–杆菌中肺炎克雷伯菌和鲍曼不动杆菌血流感染出现泛耐药菌株比例高,患者病死率高。
Objective To investigate the clinical characteristics and bacterial drug resistance of bloodstream infection of gram-negative bacteria, and provide guidance for clinical rational drug use and control of hospital infection.Methods A retrospective analysis was conducted in the patients diagnosed as severe pneumonia with blood culture of gram-negative bacteria from January 2015 to December 2017 in Beijing Anzhen Hospital. Results A total of 60 severe pneumonia patients suffered from bloodstream infection of gram-negative bacteria were recruited including 34 males and 26 females aging from 42 to 89 years and 73.4 years in average. In the 60 patients, 32 cases were infected with Klebsiella pneumonias, 20 cases were infected with Acinetobacter baumanni, and 8 cases were infected with Escherichia coli. The antimicrobial susceptibility testing result of Klebsiella pneumonias showed that the drug susceptibility rate was 100% to tigecycline, and 6.3% to amikacin. Escherichia coli was sensitive to Amikacin, imipenem, ceftazidime and meropenem while resistance to other drugs. The antimicrobial resistance of Acinetobacter baumanni was 28.6% for cefoperazone/sulbactam, and 14.3% for tigecycline. C-reactive protein, procalcitonin and SOFA scores were higher in the patients infected with Acinetobacter baumanni. Neutrophils and blood lactic acid were higher in the patients infected with Klebsiella pneumonias. There were no statistical differences in white blood cell, platelet or motality rate between the patients infected with Acinetobacter baumanni and the patients infected with Klebsiella pneumonias. SOFA scores and blood lactic acid had significantly statistical relevance with prognosis. Conclusion There is a high proportion of drug resistance of Klebsiella pneumoniae and Acinetobacter baumanni in the bloodstream infection of gram-negative bacteria.
作者
吴春婷
赵佳晖
叶晓芳
黄艳
黄立学
朱光发
WU Chunting;ZHAO Jiahui;YE Xiaofang;HUANG Yan;HUANG Lixue;ZHU Guangfa(Department of Respiratpry and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2018年第3期243-246,共4页
Chinese Journal of Respiratory and Critical Care Medicine
关键词
血流感染
肺炎克雷伯菌
鲍曼不动杆菌
耐药
Bloodstream infection
Klebsiella pneumonias
Acinetobacter baumanni
Antimicrobial resistance
