102例胸外科手术患者肺炎克雷伯菌血流感染的临床特征及其对抗菌药物的敏感性分析

Analysis on Clinical Characteristics of Klebsiella Pneumoniae Bloodstream Infection and Its Sensitivity toAntimicrobials in 102 Patients Undergoing Thoracic Surgery

目的:分析医院胸外科手术患者肺炎克雷伯菌血流感染的临床特征及其药敏试验结果,为胸外科术后肺炎克雷伯菌血流感染患者抗菌药物的合理使用提供参考。方法:抽取2015年1月—2018年1月间胸外科收治的手术治疗后并发肺炎克雷伯菌血流感染患者102例资料,分析其肺炎克雷伯菌血流感染的临床特征及其对抗菌药物药敏试验结果。结果:102例血流感染患者标本中,检出102株肺炎克雷伯菌;肺炎克雷伯菌在不同胸外科手术中,其中胃癌根治术、气管切开术及胸腔穿刺术的血流感染率分别为33.33%、21.57%和16.67%;血流感染主要发生在男性患者占61.76%,而其年龄≥60周岁占比为60.78%,有放/化疗史的患者占比为36.27%,微创手术占比为30.39%,开胸手术占比高达69.61%,合并糖尿病和高血压患者占比分别为23.53%和29.41%;药敏试验结果显示,肺炎克雷伯菌对氨苄西林的耐药率为100.00%,而对呋喃妥因、头孢唑林、阿莫西林、复方磺胺甲噁唑等抗菌药物的耐药率均较高,但对其他抗菌药物的耐药性较弱;其对阿米卡星、美罗培南、亚胺培南均为敏感,而对庆大霉素、头孢吡肟、哌拉西林、头孢哌酮、头孢曲松、左氧氟沙星、头孢西丁、替加环素、环丙沙星等抗菌药物的敏感率均高于80.00%。结论:胃癌根治术、气管切开术、胸腔穿刺术后患者肺炎克雷伯菌感染发生率较高,尤其是年龄大于60周岁、有放/化疗史、伴有糖尿病或高血压、男性患者术后肺炎克雷伯菌血流感染发生率较高,治愈率较低,其病死率大于10.00%;临床应根据其药敏结果,合理选用敏感率较高的抗菌药物治疗,以确保患者术后肺炎克雷伯菌血流感染治疗的有效性。

Objective:To analyze the clinical characteristics of Klebsiella pneumoniae(KP)bloodstream infection and its sensitivity to antimicrobial agents in 102 patients undergoing thoracic surgery,and to provide reference for the rational usage of antimicrobial agents in patients with KP bloodstream infection after thoracic surgery.Methods:The data of 102 patients complicated with KP blood flow infection after surgical treatment admitted to the department of thoracic Surgery from January 2015 to January 2018 were extracted to analyze the clinical characteristics of KP blood flow infection and the results of antimicrobial susceptibility test.Results:102 strains of KP were detected in 102 patients with bloodstream infection.In different thoracic surgeries,the blood flow rate of KP was 33.33%,21.57%and 16.67%respectively in radical gastrectomy,tracheotomy and pleural puncture.Blood flow infection occurred mainly in 61.76%of male patients,60.78%of whom were aged in greater than or equal to 60 years old,36.27%of patients with radiation/chemotherapy history,30.39%of patients with minimally invasive surgery,69.61%of patients with open-heart surgery,23.53%and 29.41%of patients with diabetes and hypertension,respectively.The drug sensitivity test results showed that the drug resistance rate of KP to ampicillin was 100.00%,while the drug resistance rate of KP to furantoin,cefazolin,amoxicillin,compound sulfamethoxazole and other antibacterial drugs were all higher,but the drug resistance to other antibacterial drugs was relatively weak.It was sensitive to amikacin,meropenem and imipenem,while sensitive to gentamicin,cefepime,piperacillin,cefoperazone,ceftriaxone,levofloxacin,cefoxitin,tigecycline and ciprofloxacin were all higher than 80.00%.Conclusion:The incidence of KP infection after radical gastrectomy,tracheotomy,and pleural puncture is relatively high,especially in men who are older than 60 years old,have a history of radiotherapy or chemotherapy,accompanied by diabetes or hypertension,and the incidence of KP blood flow infection is relatively high,the cure rate is low,and the fatality rate is higher than 10.00%.In order to ensure the effectiveness of the treatment of KP blood flow infection,antimicrobial agents with high sensitivity rate should be selected reasonably based on the drug sensitivity results.