不同部位感染肺炎克雷伯菌的临床特征及耐药特点分析

Clinical characteristics and drug resistance of Klebsiella pneumoniae infections at different systems

目的探讨不同部位感染肺炎克雷伯菌的临床特征及耐药特点,为临床合理使用抗菌药物提供实验室参考。方法对2015年1月至2021年12月梧州市红十字会医院收治呼吸系统、泌尿系统、血液系统及其他部位感染肺炎克雷伯菌患者进行临床特征及耐药分析。结果2015—2021年全院检出肺炎克雷伯菌致病菌3496株,感染呼吸系统的肺炎克雷伯菌株最多2250株(64.34%);不同部位感染肺炎克雷伯菌的患者性别比例差异有统计意义(χ^(2)=266.77,P<0.001),感染呼吸道系统和血液系统肺炎克雷伯菌株数量以男性多见,感染泌尿系统的肺炎克雷伯菌数量则女性多于男性,感染其他部位的肺炎克雷伯菌男女比例相当;不同部位感染肺炎克雷伯菌患者年龄差异有统计意义(χ^(2)=176.54,P<0.001),呼吸系统、泌尿系统和血液系统感染以>60~80岁的人群最为常见,而其他部位感染以>18~60岁的人群为主;不同部位感染肺炎克雷伯菌患者科室分布差异有统计意义(χ^(2)=1415.30,P<0.001),呼吸系统感染的肺炎克雷伯菌ICU例数最多,泌尿系统和血液系统以内科最常见,而感染其他部位的肺炎克雷伯菌数量则以外科最多。感染血液系统肺炎克雷伯菌对常用的抗菌药物耐药率均低于另外三种感染部位,感染呼吸道系统、泌尿系统和其他部位的肺炎克雷伯菌对阿米卡星、美罗培南、亚胺培南、哌拉西林/他唑巴坦耐药率均低于10%,妥布霉素耐药率低于20%,其余抗菌药耐药率均在30%左右。结论不同部位感染肺炎克雷伯菌的患者在性别、年龄及科室所占比例不同;感染血液系统肺炎克雷伯菌对常见抗菌药物耐药率比另外三种感染部位低,感染呼吸系统、泌尿系统和其他部位的肺炎克雷伯菌尤其对三四代头孢菌素耐药率较高,对哌拉西林/他唑巴坦和碳青霉烯类抗菌药物仍较为敏感。

Objective To investigate the clinical characteristics and drug resistance of Klebsiella pneumoniae infections at different systems,providing laboratory reference for the rational use of antibiotics in clinical practice.Methods The clinical characteristics and drug resistance of patients with Klebsiella pneumoniae infections in respiratory,urinary,hematologic,and other systems who received treatment in Wuzhou Red Cross Hospital from January 2015 to December 2021 were analyzed.Results From 2015 to 2021,there were 3496 cases of Klebsiella pneumoniae infections in the hospital,among which the respiratory system was most affected with 2250 strains(64.34%).The sex ratio of patients with Klebsiella pneumoniae infections at different systems was statistically significant(χ^(2)=266.77,P<0.001).The respiratory system and hematological system were more commonly infected by Klebsiella pneumoniae in men,while the urinary system was more commonly infected in women.The sex ratio of patients with Klebsiella pneumoniae infections at other systems were similar.The age distribution of patients with Klebsiella pneumoniae infections at different systems was significantly different(χ^(2)=176.54,P<0.001).Klebsiella pneumoniae infections of the respiratory,urinary,and hematological systems were the most common in people aged>60-80 years,while Klebsiella pneumoniae infections in other systems were mainly found in people aged>18-60 years.There were significant differences in the distribution of departments among different Klebsiella pneumoniae infection systems(χ^(2)=1415.30,P<0.001).The ICU had the highest incidence of Klebsiella pneumoniae infections in the respiratory system,while the department of internal medicine had the highest incidence of Klebsiella pneumoniae infections in the urinary and hematological systems,and the department of surgery had the highest incidence of Klebsiella pneumoniae infections in other parts of the body.The resistance rate of Klebsiella pneumoniae to common antibiotics for the hematologic system was lower than that of the other three infection systems.For infections in the respiratory system,urinary system,and other body parts,the resistance rates of Klebsiella pneumoniae to amikacin,meropenem,imipenem,and piperacillin/tazobactam were all below 10%,while the resistance rate to tobramycin was below 20%,and the resistance rate to cephalosporins was around 30%.Conclusion The proportion of Klebsiella pneumoniae infections in different body parts varies by gender,age,and department.For Klebsiella pneumoniae infections in the hematological system,the resistance rate to commonly used antibiotics is lower than that for infections in the other three systems.In contrast,Klebsiella pneumoniae infections in the respiratory system,urinary system,and other systems have a particularly high resistance rate to third-and fourth-generation cephalosporins but are still sensitive to piperacillin/tazobactam and carbapenem antibiotics.