高毒力肺炎克雷伯菌血流感染的临床特点

目的了解高毒力肺炎克雷伯菌(hvKP)血流感染(BSI)的微生物学和临床特点。方法收集2013年4月—2016年3月大连医科大学第二临床学院159例肺炎克雷伯菌BSI患者的菌株和临床资料。应用SPSS 19.0统计软件进行分析。结果 hvKP BSI在159例肺炎克雷伯菌BSI患者中占35.22%(56/159),其中K1和K2型分别占51.79%和26.79%。hvKP BSI感染来源主要为肝脓肿(26株,46.43%),经典型肺炎克雷伯菌(cKP)BSI主要是原发性菌血症(41株,39.81%)。两组患者不同感染类型比较,差异有统计学意义(χ2=57.782,P0.001),hvKP BSI患者以社区获得性为主(89.29%),cKP BSI患者以医院获得性为主(73.79%)。两组患者不同基础疾病构成比较,差异有统计学意义(χ2=36.532,P0.001),hvKP BSI患者主要为糖尿病(50.00%),cKP BSI患者主要为恶性肿瘤(45.63%)。hvKP BSI患者感染性休克发生率高于cKP BSI患者(32.14%vs 8.74%),差异有统计学意义(χ2=14.096,P0.001)。hvKP产ESBLs的比率为5.36%(3/56),cKP产ESBLs的比率为47.57%(49/103),二者差异有统计学意义(χ2=29.375,P0.001)。未发现产KPC的hvKP。hvKP对头孢他啶、头孢曲松、头孢吡肟、氨曲南、庆大霉素、左氧氟沙星及复方磺胺甲口恶唑的耐药率均低于cKP,差异有统计学意义(均P0.05)。结论 hvKP BSI多见于社区感染,感染来源和基础疾病不同于cKP BSI,易产生感染性休克。实验室和临床医生都应重视hvKP感染并密切关注其耐药趋势的演变。

Clinical features of hypervirulent Klebsiella pneumoniae bloodstream infection

ObjectiveTo understand the microbiological and clinical features of bloodstream infection(BSI) with high virulent Klebsiella pneumoniae(hvKP). MethodsThe strains and clinical data of 159 patients with Klebsiella pneumoniae (K. pneumoniae) BSI at the Second Hospital of Dalian Medical University from April 2013 to March 2016 were collected. Statistical analysis was performed using SPSS 19.0 software. Results35.22%（56/159）of patients were with hvKP BSI, K1 and K2 serotypes in hvKP BSI accounted for 51.79% and 26.79% respectively. The main source of hvKP BSI was liver abscess（n=26，46.43%），the classic type of K. pneumoniae (cKP) BSI was primary bacteremia（n=41，39.81%）. Difference in different types of infection between two groups of patients was statistically significant（χ2=57.782，P＜0.001），89.29% of hvKP BSI was community associated infection(CAI), and 73.79% of cKP BSI was healthcare associated infection(HAI). Difference in underlying diseases between two groups of patients was statistically significant（χ2=36.532，P＜0.001），50.00% of hvKP BSI patients had diabetes, 45.63% of cKP BSI patients had malignant tumor. Icidence of septic shock in hvKP BSI patients was higher than that of cKP BSI patients（32.14% vs 8.74%; χ2=14.096，P＜0.001）. The proportion of ESBLs producing of hvKP and cKP were 5.36% （3/56）and 47.57%（49/103）respectively，difference was statistically significant（χ2=29.375，P＜0.001). Klebsiella pneumoniae carbapemase(KPC) producing hvKP was not found. Resistance rates of hvKP to ceftazidime, ceftriaxone, cefepime, aztreonam, gentamicin, levofloxacin, and compound sulfamethoxazole were all lower than cKP(all P<0.05). ConclusionhvKP BSI is common in CAI, infection sources and underlying diseases are difference from cKP BSI, hvKP BSI is prone to cause septic shock. Both laboratories and clinicians should pay attention to hvKP infection and the change trend of antimicrobial resistance.