阴沟肠杆菌血流感染52例临床分析

Clinical analysis of 52 cases with Enterobacter cloacae bloodstream infection

目的调查分析阴沟肠杆菌血流感染的临床特点、耐药情况、危险因素以及目前我院流行病学等特点。方法调查从2000—2005年5月血培养阴沟肠杆菌阳性的病例,回顾性调查相关的病史资料和实验室数据。结果共纳入52例,其中25例是泌尿外科患者。医院感染共有45例。6例患者为原发感染。1株细菌对亚胺培南-西司他丁耐药,30株对头孢曲松、头孢噻肟、头孢他啶和头孢吡肟耐药。7例患者因血流感染死亡。结论阴沟肠杆菌血流感染相对少见,但其发生率呈上升趋势;我院以泌尿外科患者最多见,泌尿外科手术和导尿管的放置是主要危险因素。其他还有肾移植、糖皮质激素或细胞毒性药物的应用以及广谱抗生素应用等。头孢菌素类的应用是产生耐药性的重要危险因素之一。阴沟肠杆菌对抗菌药物多呈多重耐药性,尤其对广谱头孢菌素耐药率高。经恰当的抗感染治疗,多数患者可获生存。

Objective To study the clinical and microbiological features, antimicrobial resistance patterns, possible risk factors in patients with bloodstream infection caused by E. cloacae. Methods We reviewed the records about bloodstream infection caused by E. cloacae from 2000 to May 2005, and retrospectively analyzed the corresponding laboratory findings and medical records. Results A total of 52 cases were included in this analysis, 25 were from Department of Urology. Forty-five cases were hospital-acquired infection. Primary infection was identified in 6 cases. One E. cloacae strain was resistant to imipenem, and 30 were resistant to third- and fourth-generation cephalosporins. Seven patients died of bloodstream infection. Conclusions In our hospital, bloodstream infection caused by E. cloacae is not a common infection. The patients in Department of Urology are vulnerable to E. cloacae bloodstream infection. Urological surgery and urinary catheter placement are major contributing factors for E. cloacae bloodstream infection. Other risk factors include kidney transplantation, prior use of antibiotic, corticosteroids and cytotoxic therapy. E. cloacae isolates from bloodstream infection are usually multi-drug resistant, especially to broad-spectrum cephalosporins. Most patients can survive after appropriate therapy.