77例肺炎克雷伯菌致血流感染的患者临床特征和预后分析

Clinical characteristics and prognosis of 77 bloodstream infections caused by Klebsiella pneumoniae

目的分析肺炎克雷伯菌导致血流感染患者的临床特征与感染菌株的药敏情况,探究容易感染仅对氨苄西林耐药菌株患者的临床特征,寻找影响预后的可能因素。方法回顾性分析2019年1月1日至2021年12月31日福州市第二医院收治的77例肺炎克雷伯菌导致血流感染患者的临床资料。进行血液细菌培养,阳性标本行菌株鉴定及药敏分析。根据肺炎克雷伯菌药敏试验结果,将患者分为仅对氨苄西林耐药菌株组(51例)和非仅对氨苄西林耐药菌株组(26例)。根据临床转归,将患者分为预后良好组(55例)与预后不良组(22例)。对不同组间患者的临床资料、实验室指标、药敏试验结果与临床干预措施进行单因素分析与二元多因素Logistic分析。结果共检出77株肺炎克雷伯菌,其中碳青霉烯类敏感肺炎克雷伯菌70株(90.9%),碳青霉烯类耐药肺炎克雷伯菌7株(9.1%)。在仅对氨苄西林耐药菌株组与非仅对氨苄西林耐药菌株组间,患者是否入住ICU、年龄、合并糖尿病以及肝脓肿的各项影响因素的差异均具有统计学意义(P<0.05)。在预后良好组与预后不良组间,包括最低白蛋白水平、最低血色素水平、最低血小板计数水平、患者是否入住ICU、感染碳青霉烯类耐药菌株以及合并脓毒症的各项指标,差异具有统计学意义(P<0.05)。合并脓毒症(OR=4.939,95%CI:1.208~20.201,P=0.026)是预后不良的独立危险因素。结论合并糖尿病的肝脓肿患者更易出现肺炎克雷伯菌导致的血流感染。患者感染碳青霉烯耐药的肺炎克雷伯菌、实验室检查结果提示血白蛋白水平、血色素水平与血小板水平严重降低可能与不良预后相关。肺炎克雷伯菌导致血流感染的患者合并脓毒症是预后不良的独立危险因素。

Objective To explore the clinical characteristics of patients susceptible to Klebsiella pneumoniae resistant to ampicillin and possible factors affecting the prognosis.Method The medical records were collected from 77 adult patients with bloodstream infection caused by Klebsiella pneumoniae between January 1,2019 and December 31,2021.Automatic blood culture apparatus was used for bacterial culture,and automatic bacterial analyzer was used for strain identification and drug sensitivity analysis of positive specimens.According to the susceptibility test results of Klebsiella pneumoniae,the patients were divided into two groups:ampicillin resistance group(n=51,66.2%)and non-ampicillin resistant strain group(n=26,33.8%).According to the clinical outcome,the patients were divided into good prognosis group(n=55,71.4%)and poor prognosis group(n=22,28.6%).Univariate analysis and binary multivariate logistic analysis were performed on the clinical data,laboratory indicators,drug susceptibility test results and clinical intervention measures of patients in different groups to explore the related factors and independent risk factors of patients'susceptibility to ampicillin resistant strains,as well as the related factors and independent risk factors leading to poor prognosis of patients.Result A total of 77 strains of Klebsiella pneumoniae were detected,including 70 CSKP strains(90.9%)and 7 CRKP strains(9.1%).There were statistically significant differences(P<0.05)between the ampicillin resistance group and non-ampicillin resistant strain group(P<0.05)in the following indicators:ICU admission,age,diabetes mellitus and liver abscess.ICU admission(OR=0.116,95%CI:0.025-0.538),age(OR=0.956,95%CI:0.914-1.000),diabetes(OR=3.741,95%CI:1.046-13.376)and liver abscess(OR=11.522,95%CI:1.844-71.987)were independent risk factors for ampicillin resistant strains(P<0.05).There were statistically significant differences between the good prognosis group and the poor prognosis group(P<0.05)in the following indicators:the lowest albumin level,the lowest hemoglobin level,the lowest platelet count level,ICU admission,infection with carbapenemresistant strains,and sepsis.Comorbid sepsis(OR=4.939,95%CI:1.208-20.201,P=0.026)was an independent risk factor for poor prognosis.Conclusion Patients having liver abscess comorbid with diabetes are more likely to develop bloodstream infection caused by Klebsiella pneumoniae.Bacterial susceptibility tests in patients with carbapenem-resistant Klebsiella pneumoniae was associated with poor prognosis.Serious reduction in blood albumin levels,hemoglobin levels and platelet levels may be associated with poor prognosis.Sepsis in patients with bloodstream infection caused by Klebsiella pneumoniae is an independent risk factor for poor prognosis.