作　　者： (李兰玉）; (朱长清）; (黄欢）;

机构地区： 上海交通大学医学院附属仁济医院急诊科,上海200127

出　　处： 《临床急诊杂志》 2017年第8期592-596,共5页

摘　　要： 目的:探讨超广谱β-内酰胺酶(ESBL)肺炎克雷伯菌血源感染(Kp-BSIs)的概括及病死率。方法:收集2011-06-2015-06我院收治的111例肺炎克雷伯菌血源感染患者资料,按ESBL阳性与阴性分组,单因素Logistic回归分析年龄、性别、基础疾病、侵袭性器械使用、细菌耐药等因素在2组间的差异,多因素Logistic回归分析Kp患者ESBL阳性的独立危险因素。结果:(1)ESBL阳性组病死率高于ESBL阴性组(P=0.015);(2)ESBL阳性组的住院时间、菌血症发生前住院时间等明显高于ESBL阴性组(P=0.029,P=0.013),ESBL阳性组接受胸腹腔引流管、中心静脉导管、导尿管等侵袭性器械使用的比例更高(P=0.009,P=0.037,P=0.014);(3)ESBL阳性组耐药率更高;(4)哌拉西林-他唑巴坦耐药(OR=5.618,P=0.057)和留置导尿管(OR=1.023,P<0.001)是Kp-BSIs患者产ESBL的独立危险因素;(5)生存曲线显示ESBL阳性组在BSI发生后的90d生存率明显低于ESBL阴性组。结论:ESBL阳性Kp患者病死率高,接受侵袭性器械使用比例高,耐药率高。留置导尿管和哌拉西林-他唑巴坦耐药为ESBL阳性的独立危险因素。 Objective：To study the clinical characteristics and risk factors for mortality of bloodstream infection caused by extended-spectrumβ-lactamase-producing Klebsiella pneumonia（ESBL-Kp）.Method：We analyzed the data of the clinical characteristics of 111 patients with Klebsiella pneumoniabloodstream infections（Kp-BSIs）admitted to our hospital from June 2011 to June 2015.The patients were divided to two groups according to the extended spectrumβ-lactamase positive and negative.Age,sex,underlying diseas,using invasive devices,drug resistance and other factors were campared between the two groups.Risk factors related to ESBL-Kp isolates were summarized and analyzed by using binary Logistic regression model.Result：（1）A significantly higher mortality rate was observed in ESBL-positive group（P=0.015）.（2）Length of stay（LOS）,length of stay before BSI onset（LOS before BSI）in ESBL-positive group were longer than those in ESBL-negative group（P=0.029,P=0.013）.And there was higher frequency of the application of invasive instruments in ESBL-positive group,such as thoracic and abdominal drainage tubes,central venous catheter,bladder catheter and so on（P=0.009,P=0.037,P=0.014）.（3）The drug-resistance rate of ESBL-positive group was higher.（4）Piperacillin-tazobactam resistant（OR=5.618,P=0.057）and indwelling catheter（OR=1.023,P〈0.001）were independent risk factors for ESBL production in patients with Kp-BSIs.（5）Survival curves showed that the 90-day survival rate of ESBL-positive group was significantly lower than that of ESBL-negative group after BSI occurred.Conclusion：ESBL-Kp positive patients has high mortality,high proportion of invasive devices and high drug-resistance rate.Indwelling catheter and piperacillintazobactam resistant are the independent risk factors to ESBL-positive patients.

关 键 词： 超广谱 内酰胺酶 肺炎克雷伯菌 血源感染 危险因素 病死率