肺炎克雷伯菌与大肠埃希菌所致血流感染患者的临床分布及疾病负担差异比较

Distribution and disease burden of bloodstream infection due to Klebsiella pneumoniae and Escherichia coli

目的研究肠杆菌科细菌中肺炎克雷伯菌与大肠埃希菌所致血流感染患者的临床分布特征和疾病经济负担的差异。方法回顾性调查2014年1月-2015年12月医院肺炎克雷伯菌或大肠埃希菌所致血流感染的住院患者436例,分别对其临床科室分布及住院时间、住院费用分析比较。结果共纳入436例患者,其中肺炎克雷伯菌感染患者154例占35.3%,大肠埃希菌感染患者282例占64.7%;最多见的临床科室分布为肝胆外科、重症监护室和肿瘤科,其中肺炎克雷伯菌感染多分布于重症监护室(25.3%)和肝胆外科(22.7%);大肠埃希菌感染多分布于肿瘤科(17.1%)、肝胆外科(16.5%)和消化内科(10.3%);肺炎克雷伯菌血流感染患者的住院时间(P=0.007)及住院费用(P<0.001)均显著高于大肠埃希菌血流感染患者;住院时间和住院费用由高到低的科室依次为重症监护室、血液科、肝胆外科、肿瘤科等。结论肺炎克雷伯菌和大肠埃希菌所致血流感染患者在医院分布广泛,且两种细菌血流感染的临床科室分布存在差异,肺炎克雷伯菌所致血流感染患者的住院时间更长、住院费用更高,临床工作中应该对肝胆外科、重症监护室及肿瘤科等高危科室进行重点监控,以更有效地控制相关感染。

OBJECTIVE To investigate the difference of clinical distribution and disease burden of bloodstream infection（BSI）due to Klebsiella pneumoniae and Escherichia coli.METHODS A retrospective study was conducted on436 cases of hospitalized patients with BSI caused by K.pneumoniae or E.coli from Jan.2014 to Dec.2015,and their department distribution,duration of hospitalization and hospitalization costs were analyzed and compared.RESULTS Four hundred and thirty-six cases of BSI were enrolled in our study,including 154（35.3%）cases of K.pneumoniae BSI and 282（64.7%）cases of E.coli BSI.The most common clinical department distribution were Department of Hepatobiliary Surgery,Intensive Care Unit and Department of Oncology.K.pneumoniae BSI were more common in Intensive Care Unit（25.3%）and Department of Hepatobiliary Surgery（22.7%）,while E.coli BSI were more common in Department of Oncology（17.1%）,Department of Hepatobiliary Surgery（16.5%）and Department of Gastroenterology（10.3%）.The duration of hospitalization（P=0.007）and hospitalization cost（P〈0.001）of patients with K.pneumoniae infection were significantly higher than those of patients with E.coli BSI.hospitalization time and Hospitalization costs from high to low were Intensive Care Unit,Department of Hematology,Department of Hepatobiliary Surgery and Department of oncology.CONCLUSIONPatients with BSI due to K.pneumoniae and E.coli distribute widely in our hospital,and the clinical distribution of the two pathogens was also significantly different.In contrast to BSI due to E.coli,cases of K.pneumoniae BSI are associated with significantly prolonged hospital stay and increased costs.Infection prevention measures should be focused on Department of Hepatobiliary Surgery,Intensive Care Unit and Department of Oncology,so as to more effectively control related infection.