高黏液型肺炎克雷伯菌感染的临床分析及耐药性分析

目的 回顾性调查新乡市检出肺炎克雷伯菌患者临床资料及药敏报告,阐明高黏液型肺炎克雷伯菌引起感染患者的临床分析及其耐药性,为临床抗感染诊疗合理选择抗菌药物提供参考依据。方法 收集新乡市2018年5月至2019年5月非重复性肺炎克雷伯菌1 638株。转血平板,通过黏液丝试验,分出高黏液型肺炎克雷伯菌,查阅患者的临床病历资料,分析感染患者的年龄、所在病区、标本来源、感染指标、血糖及药敏结果,数据采用SPSS 19.0 进行统计学分析。结果 1 638株肺炎克雷伯菌,其中经典肺炎克雷伯菌1 354株,占82.7%;高黏液型肺炎克雷伯菌 284 株,占17.3% 。高黏液型肺炎克雷伯菌引起感染患者临床分布主要为重症医学科,占33.1%;主要标本来源为痰液,占59.5%;在年龄及血糖>7.0 mmol/L浓度上与经典型肺炎克雷伯菌差异有统计学意义（P<0.05）。高黏液型肺炎克雷伯菌对各种抗菌药物的耐药率均低于经典肺炎克雷伯菌,并且多种抗菌药物耐药率差异有统计学意义（P<0.05）。产生超广谱β-内酰胺酶（ESBLs）细菌和耐碳青霉烯类抗菌药物的肠杆菌科细菌（CRE）,高黏液型肺炎克雷伯菌检出率均低于经典型肺炎克雷伯菌（P<0.05）。结论 高黏液型肺炎克雷伯菌引起感染患者所在病区、年龄、血糖、感染部位都有其特殊性,对常用抗菌药物的耐药率均低于经典型肺炎克雷伯菌。

Clinical characteristics and drug resistance of hypermucoviscous Klebsiella pneumoniae

Objective To retrospectively investigate the clinical records and drug sensitivity of patients infected with Klebsiella pneumoniae at Xinxiang area over the past year, to identify the clinical characteristics and drug resistance of hypermucoviscous Klebsiella pneumoniae (hmKP), and to provide a guidance for reasonable use of antibiotics in clinical anti-infection management. Methods From May 2018 to May 2019, a total of 1 638 non-repetitive Klebsiella pneumoniae strains were collected, from which hmKP was sorted out through string test after inoculation in blood agar. By reviewing the patients' clinical records, SPSS19.0 software was used to statistically analyze data such as age, inpatient area, specimen source, indicators of infection, blood glucose and drug sensitivity results of infected patients. Results Among 1 638 strains of Klebsiella pneumoniae, 1 354 strains (82.7%) were classic Klebsiella pneumoniae (cKP), 284 strains (17.3%) were hmKP. Data showed 33.1% of hypermucoviscous Klebsiella pneumoniae (hmKP) infection cases was clinically admitted in intensive care medicine department. 59.5% of the samples were taken in form of sputum. There were significant differences between hmKP and cKP in age and blood glucose (>7.0 mmol/L) samples (P<0.05). The resistance rate to various antibacterial drugs of hmKP was lower than cKP, with significant variability for resistance rate of hmKP to multiple drugs (P<0.05). The detection rate of both extended-spectrum beta-lactamases (ESBLs) and carbapenem-resistant Enterobacteriaceae (CRE) were lower in hmKP than cKP (P<0.05). Conclusion Patients infected with hmKP have particularity in inpatient area, age, blood glucose and infection site, and the drug resistance of hmKP to commonly used antibiotics is lower than that of cKP.