肺炎克雷伯菌血流感染合并糖尿病的临床特征及耐药性分析

Analysis of clinical characteristics and drug resistance of Klebsiella pneumoniae bloodstream infection with diabetes mellitus

目的:探讨肺炎克雷伯菌血流感染伴有糖尿病患者的临床特征及耐药情况,为病情评估及临床治疗提供理论依据。方法:收集2018年1月—2019年9月汕头市中心医院确诊肺炎克雷伯菌血流感染的成年住院患者85例,根据患者是否患有糖尿病分为糖尿病组(50例)和非糖尿病组(35例),对其临床特征及耐药情况进行回顾性分析。结果:糖尿病组肝脓肿17例(34.0%),泌尿系感染12例(24.0%),严重脓毒血症及休克27例(54.0%),白蛋白(27.24±5.60)g/L;非糖尿病组肝脓肿5例(14.3%),无泌尿系感染,严重脓毒血症及休克9例(25.7%),白蛋白(31.21±7.49)g/L,差异均有统计学意义(P<0.05)。细菌药敏实验结果显示,糖尿病组对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢他啶、头孢吡肟、头孢曲松、阿莫西林/克拉维酸、左氧氟沙星、复方新诺明、头孢呋辛、头孢呋辛酯的敏感性均高于非糖尿病组(P<0.05)。结论:肺炎克雷伯菌血流感染合并糖尿病患者的临床症状较非糖尿病患者严重,易出现严重低蛋白血症和发生严重脓毒血症及休克,对大多数抗生素的敏感性高于非糖尿病患者。

Objective:To investigate the clinical characteristics and drug resistance of patients with Klebsiella pneumoniae bloodstream infection and diabetes,and to provide a theoretical basis for disease evaluation and clinical treatment.Methods:85 adult inpatients with Klebsiella pneumoniae bloodstream infection diagnosed in Shantou Central Hospital from January 2018 to September 2019 were collected and divided into diabetic group(50 cases)and non-diabetic group(35 cases)according to whether they had diabetes.Clinical features and drug resistance were analyzed retrospectively.Results:In the diabetic group,17 cases(34.0%)of liver abscess,12 cases(24.0%)of urinary tract infection,27 cases(54.0%)of severe sepsis and shock,albumin(27.24±5.60)g/L;In non-diabetic group,5 cases(14.3%)of liver abscess,no urinary tract infection,9 cases(25.7%)of severe sepsis and shock,albumin was(31.21±7.49)g/L,the difference were all statistically significant(P<0.05).The results of bacterial susceptibility test showed that the sensitivity of diabetes group to piperacillin/tazobactam,cefoperazone/sulbactam,ceftazidime,cefepime,ceftriaxone,amoxicillin/clavulanic acid,levofloxacin,compound sulfamethoxazole,cefuroxime and cefuroxime axetil were higher than those of non-diabetes group(P<0.05).Conclusion:Klebsiella pneumoniae bloodstream infection patients with diabetes have more severe clinical symptoms than non-diabetic patients,and are prone to severe hypoproteinemia,severe sepsis and shock,and are more sensitive to most antibiotics than non-diabetics patient.