成人肺炎克雷伯菌败血症53例临床分析

Analysis of clinical features of 53 cases with Klebsiella pneumoniae septicemia in adults

目的探讨肺炎克雷伯菌败血症临床特点和致病菌药敏情况，为临床诊断和合理用药提供依据。方法回顾性分析四川大学华西医院2002年10月～2007年10月5年中诊断为肺炎克雷伯菌败血症的所有病例，分析临床特点、基础疾病及微生物学特征。结果53例患者中，医院感染26例（49．1％），社区感染27例（50．9％）。社区感染患者常见基础疾病依次是糖尿病（59．3％），肝脓肿（55．6％），肺部感染（37％）。医院感染患者依次是恶性肿瘤（46．1％），肺部感染（26．9％），重症胰腺炎（19．2％），医院感染者更易发生多器官功能衰竭。社区感染主要见于内分泌科与感染科，医院感染见于血液科与ICU。所有菌株对氨苄西林均不敏感，对亚胺培南敏感性高（98．11％），菌株对第三、第四代头孢菌素敏感率社区感染菌96．3％、医院感染菌34．6%。结论肺炎克雷伯菌败血症主要见于内分泌科、血液科、感染科与ICU，医院感染肺炎克雷伯菌较社区感染菌株更加耐药，且为耐药性强的多重耐药，应重视肺炎克雷伯菌败血症的防治，重视抗菌药物合理应用。

Objective To analyse the clinical characteristics of Klebsiella pneumoniae septicemia and bacterial drug resistance so as to guide clinical diagnosis and rational use of antimicrobial agents. Methods A retrospective study was carried out in 53 adult patients of Klebsiella pneumoniae septicemia from October 2002 to October 2007 in West China Hospital of Sichuan University. The clinical feature, the underlying diseases and microbilogical characteristics were analysed. Results In 53 cases, 26 were hospital infection （49. 1%）, the other were community infection （50.9%）. Community acquired infection patients were complicated by diabetes mellitus （59.3%）, liver abscess （55.6%） and pulmonary infection （37%）. Hospital infection patients were with malignant tumor （46. 1%）, pulmonary infection （26. 9%）, severe pancreatitis （19.2%） and more vulnerable to MODS. Community infected patients mainly distributed in endocrinology department and infectious diseases department, hospital infected patients mainly distributed in hematology department and ICU. All Klebsiella pneumoniae strains were nonsusceptible to ampicillin, highly sensitive to imipenem （98.11%）. The sensitive rate of community-acquired strains to the third and the fourth generation cephalosporins was 96.3%, that of hospital-acquired strains was 34.6%. Conclusion The hospital-acquired strains was more resistant than community-acquired strains. The septicemia patients mainly distributed in endocrinology, hematology and infectious diseases departments and ICU. The antibiotics resistance of hospital infection of Klebsiella pneumoniae septicemia was a challenge. Therefore, it is important to prevent the septicemia from Klebsiella pneumoniae and pay attention to the rational use of antimicrobials.