产超广谱β-内酰胺酶肺炎克雷伯菌血流感染的耐药性、危险因素和治疗分析

Drug resistance,risk factors and treatment for sepsiscaused by extended-spectrumβ-lactamase-producing Klebsiella pneumonia

目的探讨产ESBLs肺炎克雷伯菌血流感染的耐药特点、危险因素、及治疗转归。方法收集我院2014年至2018年3月以来139例成人肺炎克雷伯菌血流感染患者的临床、药敏资料、治疗情况。结果 139例患者中,检出产ESBLs菌株共27例,且其耐药率明显高于非产ESBLs组,其中对于青霉素类、氨曲南耐药率为100%,第三和第四代头孢耐药率>85%。单因素分析显示,实体瘤、近3个月内留置深静脉导管或经外周静脉置入中心静脉导管(PICC)以及近3个月留置尿管的患者在产ESBLs组中的比例高于非产ESBLs组。多因素Logistic回归分析发现,近3个月留置深静脉导管或PICC,以及留置尿管是ESBLs肺炎克雷伯菌血流感染的独立危险因素。早期经验性治疗选用碳青霉烯、头孢哌酮舒巴坦有效率较高。对于产ESBLs菌株,第三、四代头孢或喹诺酮类临床疗效较差。结论肺炎克雷伯菌耐药情况严峻,留置深静脉导管以及尿管是产ESBLs血流感染的独立危险因素。碳青霉烯及酶抑制复合剂是治疗肺炎克雷伯菌血流感染的有效选择。

Objective To investigate the drug resistance,risk factors,treatments and outcomes of sepsis caused by extended.spectrumβ-lactamase(ESBL).producing Klebsiella pneumoniae(KP).Methods Clinical data of 139 cases with K.pneumoniae-induced sepsis from 2014 to Mar.2018 were collected and analyzed.Results Among 139 patients,27 were infected with ESBLs-producing KP strains.The resistance rates of ESBLs-producing strains were 100%for penicillin,aztreonam and above 85%for third/fourth generation cephalosporins,which were significantly higher than the patients with non-ESBLsproducing strains.The univariate analysis found that patients with solid tumor,indwelling central venous catheter,percutaneous central catheter,or indwelling catheter over 3 months were associated with the infection of ESBLs-producing KP strains.Multivariate Logistic regression analysis showed that indwelling central venous catheter or catheter were independent risk factors for ESBLs-producing K.pneumoniae infection.Empiric antibiotic therapy with carbapenems or cefperazone.Sulbactam was more effective,but the third/fourth.generation cephalosporins or quinolones benefited less for ESBLs-producing strains.Conclusions Drug resistance of K.pneumoniae is severe.The indwelling central venous catheter and indwelling catheter are risk factors for ESBLs-producing K.pneumoniae infection.Carbapenems andβ.Lactamase inhibitor compound preparationcan be considered an effective therapeutic option.