113例肠杆菌科细菌血流感染临床特征与病原分析

目的 探讨肠杆菌科细菌血流感染临床特征和病原分布，为经验抗菌治疗及合理用药管理提供参考。方法 回顾性调查2015年1月1日—2018年12月31日入住嵊州市中医院确诊为肠杆菌科细菌血流感染的所有成年病例共113例，根据致病菌是否为多重耐药，分为MDR组及非MDR组，分析患者病情、感染状况、病原检测与药敏结果。结果 113例肠杆科细菌血流感染MDR组62例，非MDR组51例。72例(63.7%)为社区获得感染，79.6%(90/113)由腹腔和泌尿系感染继发；APACHE II、SOFA评分均值分别为13.5(±6.6)分、5.3(±4.5)分，33例(29.2%)因感染入住重症监护室(ICU)，24例(21.2%)存在感染性休克。MDR组感染前2周内抗菌药物暴露比例显著高于非MDR组(P<0.001)，而平均CRP水平更低(P<0.001)。临床分离菌以大肠埃希菌居首，占50.4%(57/113)，肺炎克雷伯菌占36.3%(41/113)，MDR组肺炎克雷伯菌比例明显低于非MDR组；113株肠杆菌科细菌对亚胺培南、厄他培南、阿米卡星、哌拉西林/三唑巴坦等耐药率较低，分别为8.0%、8.0%、8.8%和13.3%。36例(31.9%)治疗失败，66例(58.4%)治疗有效，11例(9.7%)治愈，非MDR组治疗失败率(33.3%)略高于MDR组(29.0%)，但差异不具有统计学意义(P=0.623)。结论 本院肠杆菌科细菌血流感染总体病情较重；病原以大肠埃希菌、肺炎克雷伯菌为主，对哌拉西林/三唑巴坦、阿米卡星、亚胺培南、厄他培南等耐药率较低；血流感染前抗菌药物暴露是MDR的重要危险因素；临床应重视感染灶的清除和引流、迁移灶的及时发现与干预，这有利于提高治疗效果，同时降低对抗菌药物的依赖。

The clinical characteristics and pathogens in 113 adult patients with Enterobacteriaceae bacteria blood infections#br#

Objective To investigate the clinical characteristics and pathogen distribution of Enterobacteriaceae bloodstream infections, aiming to optimize antibiotic use and to promote antimicrobial stewardship. Methods A retrospective investigation was performed between January lst, 2015 and December 31st, 2018, which enrolled all adult patients with Enterobacteriaceae bacteria blood infections discharged from Shengzhou Hospital of Traditional Chinese Medicine. A total of 113 patients were reviewed. The patients were divided into MDR group and non-MDR group according to whether the pathogenic bacteria were multi-drug resistant. The patients' condition, infection severity, pathogen detection, and drug sensitivity results were analyzed. Results There were 62 cases in the MDR group and 51 cases in the non-MDR group. 72 cases (63.7%) were community-acquired, and 79.6% (90/113) were secondary to abdominal and urinary tract infections. The mean scores of APACHE II and SOFA were 13.5(6.6) and 5.3(4.5), respectively. 33 cases (29.2%) were admitted to the ICU due to infections, and 24 cases (21.2%) had septic shock. The proportion of antimicrobial drug exposure in the MDR group was significantly higher than that in the non-MDR group (P<0.001) and the mean CRP level was lower (P<0.001). Escherichia coli accounted for 50.4% (57/113) of the clinical isolates, and Klebsiella pneumoniae accounted for 36.3%(41/113). The proportion of Klebsiella pneumoniae in the MDR group was significantly lower than that in the non-MDR group. The resistance rate of 113 Enterobacteriaceae bacteria to imipenem, ertapenem, amikacin, piperacillin/tazobactam were 8.0%, 8.0%, 8.8% and 13.3%, respectively. The treatment failure rate in the non-MDR group (33.3%) was slightly higher than that in the MDR group (29.0%) (P=0.623). Conclusion In our hospital, Enterobacteriaceae bacteria blood infections were generally serious. The pathogens were mainly Escherichia coli and Klebsiella pneumoniae, with low drug resistance rate to piperacillin/tazobactam, amikacin, imipenem and ertapenem. Antimicrobial drug exposure before bloodstream infections is an important risk factor for MDR. Clinical attention should be paid to the removal and drainage of the infected site, the timely detection and intervention of migratory lesions, which improve the treatment effect and reduce the dependence on antibiotics.