摘要
目的:分析肺炎合并革兰阴性杆菌血流感染患者的临床特征及相关细菌的耐药性。方法:选取2017年8月—2022年4月哈尔滨医科大学附属第二医院呼吸内科收治的确诊为肺炎且合并革兰阴性杆菌血流感染的80例患者作为研究对象,根据血培养结果,将其分为肺炎克雷伯杆菌组(31例)和大肠埃希菌组(49例)。根据病原菌是否能产生超广谱β-内酰胺酶(ESBL),将其分为ESBL组(30例)和非ESBL组(38例),其中12例未行ESBL检测。收集患者的临床资料并进行回顾性分析。结果:肺炎克雷伯杆菌组患者的肝脓肿发生率、肝功能损害[谷草转氨酶(AST)、谷丙转氨酶(ALT)]的概率更高,发生低钾血症、低钙血症、凝血象差(PT%)的概率更高,差异有统计学意义(χ2=36.172、9.768、11.838、4.643、5.520、3.987,P<0.05);大肠埃希菌组患者的白细胞升高或降低概率更高,产ESBL概率更高,差异有统计学意义(χ2=5.877、12.812、7.060,P<0.05);ESBL组患者更易发生贫血、白细胞升高或降低;非ESBL组更易发生肝功能损害(AST、ALT)、低钾血症,差异有统计学意义(χ2=7.016、4.760、5.690、6.011、6.490,P<0.05);药敏结果提示:大肠埃希菌和肺炎克雷伯杆菌对亚胺培南、厄他培南、庆大霉素、阿米卡星、氨苄西林舒巴坦、哌拉西林他唑巴坦、阿莫西林克拉维酸、头孢哌酮舒巴坦、氨曲南、替加环素耐药率<30%。结论:肺炎合并革兰阴性杆菌血流感染患者经验性治疗首选碳青霉烯类、氨基糖苷类、广谱β-内酰胺类/酶抑制剂、氨曲南,重症患者可选择替加环素。
Objective:To analyze the clinical characteristics of patients suffering from pneumonia combined with Gram-nega⁃tive bacilli bloodstream infection and to analyze the drug resistance of the associated bacteria.Methods:80 patients diagnosed with pneumonia and combined with Gram-negative bacilli bloodstream infection admitted to the hospital from August 2017 to April 2022 were selected and divided into Klebsiella pneumoniae group(31 cases)and Escherichia coli group(49 cases)based on blood culture results.In addition,the pathogenic bacteria were divided into ESBL group(30 cases)and non-ESBL group(38 cases)ac⁃cording to whether they could produce ultra broad-spectrumβ-lactamase(ESBL),of which 12 cases did not undergo ESBL testing.Clinical data of the patients were collected and retrospectively analyzed.Results:The incidence of liver abscess,liver function im⁃pairment(glutamic aminotransferase[AST],glutamic aminotransferase[ALT]),hypokalemia,hypocalcemia,and poor coagulation(PT%)was higher in the Klebsiella pneumoniae group,with statistically significant differences(χ2=36.172,9.768,11.838,4.643,5.520,3.987,P<0.05).The E.coli group was more likely to occur in female patients,with a higher probability of elevated or reduced leukocytes and a higher probability of ESBL production,with statistically significant differences(χ2=5.877,12.812,7.060,P<0.05).The ESBL group was more likely to have anemia and elevated or decreased white blood cells,and the non-ESBL group was more likely to have liver function impairment(AST,ALT)and hypokalemia,with statistically significant differences(χ2=7.016,4.760,5.690,6.011,6.490,P<0.05).Drug sensitivity results suggest that Escherichia coli and Klebsiella pneumoniae are<30%resis⁃tant to imipenem,ertapenem,gentamicin,amikacin,ampicillin sulbactam,piperacillin tazobactam,amoxicillin clavulanic acid,cefo⁃perazone sulbactam,aminotransomide,and tigecycline.Conclusion:Carbapenems,aminoglycosides,broad-spectrumβ-lactams/en⁃zyme inhibitors,aminoglutethimide,and tigecycline are preferr
作者
王云鹏
韩开宇
胡小漫
王文玉
郑伟利
Wang Yunpeng;Han Kaiyu;Hu Xiaoman(The Second Affiliated Hospital of Harbin Medical University,Harbin,Heilongjiang,150086,China)
出处
《黑龙江医学》
2023年第20期2437-2440,共4页
Heilongjiang Medical Journal
关键词
肺炎
血流感染
大肠埃希菌
肺炎克雷伯杆菌
耐药
Pneumonia
Bloodstream infection
Escherichia coli
Klebsiella pneumoniae
Drug resistance
