肺炎克雷伯菌肺部感染临床特征分析

Clinical characteristics of patient with Klebsiella pneumoniae pulmonary infection

目的总结肺炎克雷伯菌肺部感染临床特点。方法对2019年-2021年某三甲中医院肺炎克雷伯菌肺部感染患者(KP,Klebsiella pneumoniae)进行回顾性研究,根据药敏结果分为耐碳青霉烯类肺炎克雷伯菌组(CRKP,Carbapenem-resistant Klebsiella pneumoniae)和碳青霉烯类敏感肺炎克雷伯菌组(CSKP,Carbapenem-sensitive Klebsiella pneumoniae),比较两组之间的临床感染特点和药敏情况。结果CRKP组和CSKP组肺炎克雷伯菌肺部感染患者均以男性、老年、脑血管疾病为主,CRKP组发生肺部以外侵袭性感染的比例高于CSKP组(χ^(2)=5.235,P=0.022),统计显示CRKP组使用有创机械通气(χ^(2)=4.424,P=0.035)、留置导尿管(χ^(2)=4.151,P=0.042)及碳青霉烯酶类药物(χ^(2)=6.742,P=0.009)的比例高于CSKP组。CRKP组对除替加环素、阿米卡星、复方新诺明等以外的绝大部分临床常用抗生素有较高的耐药率。结论CRKP肺部感染患者需要警惕其它部位的侵袭性肺炎克雷伯菌感染,尤其需要注意高龄男性,有脑血管基础疾病的人群,CRKP肺部感染对于常用β-内酰胺类抗生素几乎全部耐药,治疗难度较CSKP组高。

Objective To summarize the clinical features of pulmonary infection caused by Klebsiella pneumoniae(KP). Methods A retrospective analysis was conducted on patients infected with Klebsiella pneumoniae in a tertiary Chinese medicine hospital from 2019 to 2021, and they were divided into carbapenem-resistant Klebsiella pneumoniae(CRKP) group and carbapenem-sensitive Klebsiella pneumoniae(CSKP) group according to drug susceptibility results. The clinical infection characteristics and drug sensitivity were compared between the two groups.Results The patients with KP in the CRKP group and the CSKP group were mainly male,elderly,and had cerebrovascular disease. The proportion of invasive infection outside the lungs in the CRKP group was higher than that in the CSKP group( χ^(2)=5. 235,P = 0. 022). Statistics showed that the CRKP group used invasive mechanical ventilation(χ^(2)=4. 424,P = 0. 035),indwelling catheters(χ^(2)=4. 151,P = 0. 042),and carbapenemase drugs( χ^(2)=6. 742,P = 0. 009) were higher than those in the CSKP group. The CRKP group had a higher resistance rate to most of the commonly used clinical antibiotics except tigecycline,amikacin,and cotrimoxazole. Conclusion Patients with CRKP pulmonary infection need to be alert to Klebsiella pneumoniae infection in other parts,especially elderly men and people with underlying diseases of craniocerebral injury. Almost all CRKP pulmonary infections are resistant to commonly used β-lactam antibiotics. The treatment difficulty was higher than that of the CSKP group.