老年人肺炎克雷伯菌属肺部感染的临床和耐药性分析

Analysis of clinical data and drug resistence of Klebsiella pneumonie in elderly patients.

目的 了解老年人克雷伯菌属肺部感染的临床特征和细菌耐药性。方法 收集我院 2 0 0 0～ 2 0 0 1年老年克雷伯菌属肺部感染 6 1例 ,从病史、症状、体征、胸部X线检查、治疗和转归等方面分析老年克雷伯菌属所致肺部感染的临床特征。用纸片法检测克雷伯菌属对阿米卡星等 12种抗生素的体外药敏检测并测 β 内酰胺酶 (ESBLs)。结果 94 .9%的患者有基础疾病 ,临床症状以发热、咳嗽、咳痰为主 ,胸部X线以含有空气支气管症的大叶肺实变 (2 6 .2 % )、小叶浸润 (5 9.9% )和肺脓肿 (14 .8% )为主要病变 ,10例 (16 .4 % )叶间隙成弧性下坠形成克雷伯菌属肺感染的特征X线征象。 6 1例患者中 ,产ESBLs菌属占 31.1% ,对多种抗生素交叉耐药 ,对亚胺培南和部分含ESBLs抑制剂的复合抗生素敏感。结论 老年人克雷伯菌属肺感染患者多有基础疾病 ,临床表现无特异性。诊断依靠病原菌检测并结合临床和X线检查 ,治疗应根据药敏测定 ,选择敏感抗菌素。对产ESBLs克雷伯菌属引起肺部感染者 ,应用亚胺培南或部分含 β 内酰胺酶抑制剂的复合物 ,或者选用药敏测定显示敏感的药物。

Objective To learn about the clinical characteristics and the drug resistance of Klebsiella pneumonie induced extensive spectrum β-lactam(ESBL). Methods Analysis of Klebsiella pneumonie lung infection,clinical symptomatology,chest X-ray,treatment and outcomes of 61 elderly patients were made in our department during 2001 to 2002.Drug sensitivity in vitro ESBL detected in 12 antibiotics including amikacin were observed in their activities to the bacterial resistance by in vitro test sensitivity drug with paper testing method for ESBL.Results 94.9% of those patients had underlying diseases and most of them presented fever, productive cough with sputum, X-ray of lobar consolidation (26.2%), lobular infiltration (59.9%) and lung abscess(14.8%) . In ten patients(16.4%) there were the specific X-ray sign,curling down of lobular fissure in Klebsiella pneumonie lung infection.Among the 61 patients, ESBL-positive Klebsiella pneumonie was 31.1%,being cross-resistant to many antibiotics, but were sensitive to imipenem and inhibitor of ESBL compounding antibiotics.Conclusion The elderly patients having Klebsiella pneumonie lung infection usually have underlying diseases with nonspecific clinical features.The diagnosis is mainly made by sputum culture in combination with clinical and radiological examination.In the treatment,one should rely on the drug sensitivity test and choose the the sensitive antibiotics. For ESBL's Klebsiella infection of lung, one should use imipenem or compound antibiotics of ESBL-inhibitor or other sensitive drugs shown by sensitivity test.