65例肺炎克雷伯菌败血症临床及耐药分析

Analysis of Clinical Features and Antibiotic Resistance of 65 Cases With Klebsiella Pneumonia

目的探讨肺炎克雷伯菌败血症(KPBSI)的临床特点、耐药性、治疗及转归。方法收集65例KPBSI成人患者临床、细菌耐药资料,治疗方案和疾病转归情况。结果肺炎克雷伯菌对亚胺培南、美罗培南、多粘菌素、头孢哌酮舒巴坦的耐药率为0。对阿米卡星、哌拉西林/他唑巴坦、左氧氟沙星敏感率均>90%。产ESBLs对药物敏感率低于非产ESBLs(P<0.05)。本组治疗总有效率73.8%(48/65),社区感染组治疗有效率82.9%(29/35),医院感染组治疗有效率63.3%(19/30)。结论 KPBSI多见于有基础疾病患者,医院感染患者产ESBLs率高、耐药明显、临床并发症严重;对于医院感染尤其是免疫力低下、基础疾病严重患者,经验治疗应首选碳青酶烯类药物。

Objecfive To investigated the clinical significance and antibiotic resistance of klebsiella,treatment and prognosis of KPBSI.Methods 65 adltu patients of KPBSI with clinical significance,antibiotic resistance,treatment and prognosis of were collected.ResultsThe rate of drug resistance of imipenem,meropenem,polymyxin and cefoperazone/sulbactamboth of which was 0.The rate of drug sensitivity of amikacin,piperacillin/tazobactam,and levofloxacin were all greater than 90%.The drug sensitive rate of the ESBLs-producing strains was significantly lower than those no-ESBLs-producing strains（P〈0.05）.The total effective rate was 73.8 %（48/65）,effective rate in community infection group was 82.9 %（29/35）,while effective rate in hospital infection group was 6 3.3 %（1 9/3 0）.ConclusionThe KPBSI,which occurs predominantly patients have underlying diseases.There are higher producing ESBLs rate,more significantly drug resistance and more serious complications on patients of hospital infection.For patients of hospital infection,empirical treatment should be preferred carbon blue enzyme alkenes medicine,especially those with immune-suppression and serious underlying diseases.