2型糖尿病并发肺炎克雷伯菌败血症的用药分析

Clinical study of drug use for type 2 diabete mellitus complicated by Klebsiella pneumoniaesepticemia

目的探讨2型糖尿病并发肺炎克雷伯菌败血症的临床特点,提高用药水平。方法对收治的36例2型糖尿病并发肺炎克雷伯菌败血症患者的临床资料进行总结分析。结果 36例肺炎克雷伯菌败血症病原菌感染部位:泌尿道5例;呼吸道20例;胆道8例;未明3例;36例中医院感染11例,占30.6%,36例血培养显示均为肺炎克雷伯菌肺炎亚种;其中18例有肝脓肿,占50.0%,20例有肝内胆管积气现象,占55.6%;36例败血症患者均给予头孢哌酮/舒巴坦与莫西沙星联合应用,治疗后4例死亡,死亡率11.1%。结论 2型糖尿病并发肺炎克雷伯菌败血症,常有迁移病灶肝脓肿和肝内胆管积气现象,强有力的抗菌药物应用及病原菌迁移病灶的处理非常重要;同时胰岛素强化降糖和对症支持治疗也是抢救成功的关键。

OBJECTIVE To explore the clinical characteristics of type 2 diabete mellitus complicated by Klebsiella pneumoniae septicemia,so as to improve the medication.METHODS The clinical data of 36 patients with type 2 diabete mellitus complicated by K.pneumoniae septicemia enrolled in hospital were summarized and analyzed.RESULTS Of the invasion pathways of the pathogens to 36 patients with K.pneumoniae septicemia,5 cases were by the urinary tract,20 cases by the respiratory tract,8 cases by the billiary tract,3 cases unknown.Eleven of 36 patients had nosocomial infections,accounting for 30.6%.Blood culture of the 36 patients indicated that the strains were all subspecies of K.pneumoniae;18 cases（50.0%）showed migrating hepatapostema,and 20 cases（55.6%） showed pneumatosis in the intrahepatic bile duct.Cefoperazone/sulbactum in combination of moxifloxacin were given to 36 patients with septicemia,and 4 patients died after the treatment with the mortality rate of 11.1%.CONCLUSION Type 2 diabet mellitus complicated by K.pneumoniae septicemia usually accompanies migrating hepatapostema and pneumatosis in the intrahepatic bile duct.Reasonable use of antibiotics and the treatment of pathogenic migration stigmatic are very important.Meanwhile,application of intensified insulin to decrease serum glucose and supportive treatment on the basis of the symptoms are the key elements of successful rescue.