|
|
- 2016
2型糖尿病患者合并肺炎克雷伯菌败血症的临床分析
|
Abstract:
摘要：目的 对糖尿病(diabetes mellitus, DM)和非DM患者合并肺炎克雷伯菌败血症的临床特征及抗生素药敏结果资料进行回顾性分析，以便为2型糖尿病(type 2 diabetes mellitus, T2DM)合并肺炎克雷伯菌败血症治疗提供理论依据。方法 收集2010年1月至2016年1月西安交通大学第一附属医院和榆林市第一医院细菌培养室记录，确定肺炎克雷伯菌败血症的患者92例，其中DM患者46例，非DM患者46例，并对他们的临床资料及药敏结果进行分析。结果 两组病例都多见于社区感染，但DM组社区感染比例更高(82.6% vs. 63%,P<0.05)；DM组更易合并胆道疾病(54.3% vs. 26.1%,P<0.05)、脂肪肝(15.2% vs. 2.17%，P<0.05)、慢性肾功能不全(21.7% vs. 2.17%，P<0.05)；非DM组更易合并肿瘤(23.9% vs. 45.6%，P<0.05)。DM组临床表现较非DM组体温升得更高(39.1±0.8 vs. 38.6±0.9，P<0.05)，且寒战(78.3% vs. 43.5%，P<0.01)、休克(15.2% vs. 2.17%, P<0.05)常见。DM组更易形成脓肿(84.7% vs. 21.7%，P<0.01)，尤其是肝脓肿(23.9% vs. 13.0%，P<0.05)、肺脓肿(10.8% vs. 0%，P<0.05)、眼内炎(10.8% vs. 0%，P<0.05)发生率较高。DM组与非DM组在抗菌素敏感率方面无明显差异，对碳青霉烯类、头孢菌素三代、四代、喹诺酮有较高的敏感性；抗菌素耐药率由高到低依次为氨苄西林、头孢菌素一代、二代、氨基糖甙类、氨曲南、磺胺类、硝基呋喃类，庆大霉素耐药率在两组之间差异有统计学意义(43.5% vs. 13.0%，P<0.01)。结论 T2DM合并肺炎克雷伯菌败血症临床表现较重，更易形成脓肿和转移性感染，死亡率较高。及时选择合理的抗生素和脓肿引流对预后至关重要。
ABSTRACT: Objective To retrospectively analyze the clinical features and antibiotic susceptibility of diabetic and non-diabetic patients with Klebsiella pneumoniae bacteremia in order to provide theoretical basis for treating type 2 diabetes mellitus Klebsiella pneumoniae bacteremia. Methods We collected bacterial culture room records from January 2010 to January 2016 in the First Affiliated Hospital of Xi’an Jiaotong University and the First Hospital of Yulin City and determined Klebsiella pneumoniae bacteremia in 92 patients, including 46 cases of DM and 46 cases of non-DM. We analyzed their clinical data and antibiotic susceptibility test results. Results Community-acquired infection was common in both the diabetic group and non-diabetic groups, but the infection rate was higher in the diabetic group (82.6% vs. 63%, P<0.05). The diabetic group was more easily complicated with biliary disease (54.3% vs. 26.1%, P<0.05), fatty liver (15.2% vs. 2.17%, P<0.05), and chronic renal insufficiency (21.7% vs. 2.17%, P<0.05). The non-diabetic group was more easily complicated with tumor (23.9% vs. 45.6%,P<0.05). The diabetic group had higher temperature rise (39.1±0.8 vs. 38.6±0.9, P<0.05), and more chills (78.3% vs. 43.5%, P<0.01) and shock (15.2% vs. 2.17%, P<0.05). The diabetic group tended to form abscesses (84.7% vs. 21.7%, P<0.01), with higher incidence of abscesses in the liver (23.9% vs. 13.0%, P<0.05) or lung (10.8% vs. 0%, P<0.05), and intraocular inflammation (10.8% vs. 0%, P<0.05) compared with the non-diabetic group. Diabetic and non-diabetic groups did not significantly differ in rates of antibiotic-sensitivity, such as
| [1] | TSAY RW, SIU LK, FUNG CP, et al. Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection[J]. Arch Intern Med, 2002, 162(9):1021-1027. |
| [2] | SHEU SJ, CHOU LC, HONG MC, et al. Risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess[J]. Zhonghua Yi Xue Za Zhi (Taipei), 2002, 65(11):534-539. |
| [3] | HSIANG CW, LIU CH, FAN HL, et al. Clinical features and computed tomography characteristics of non-Klebsiella pneumoniae liver abscesses in elderly (>65 years) and nonelderly patients[J]. Yonsei Med J, 2015, 56(2):519-528. |
| [4] | ANG M, JAP A, CHEE SP. Prognostic factors and outcomes in endogenous Klebsiella pneumoniae endophthalmitis[J]. Am J Ophthalmol, 2011, 151(2):338-344. |
| [5] | LEDERMAN ER, CRUM NF. Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics[J]. Am J Gastroenterol, 2005, 100(2):322-331. |
| [6] | BOYLE DP, ZEMBOWER TR. Epidemiology and management of emerging |
| [7] | drug-resistant gram-negative bacteria: Extended-spectrum β-lactamases and beyond[J]. Urol Clin North Am, 2015, 42(4):493-505. |
| [8] | TUMBARELLO M, SPANU T, SANGUINETTI M, et al. Bloodstream infections caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome[J]. Antimicrob Agents Chemother, 2006, 50(2):498-504. |
| [9] | 岳磊，陈雪影，庄娜，等. 健康鸡源肺炎克雷伯菌检测到质粒介导喹诺酮耐药qnrA基因[J]. 华南农业大学学报, 2012, 33(2):259-263. |
| [10] | CHEN YJ, KUO HK, WU PC, et al. A 10-year comparison of endogenous endophthalmitis outcomes: an East Asian experience with Klebsiella pneumoniae infection[J]. Retina, 2004, 24(3):383-390. |
| [11] | LEE KH, HUI KP, TAN WC, et al. Klebsiella bacteraemia: a report of 101 cases from National University Hospital, Singapore[J]. J Hosp Infect, 1994, 27(4):299-305. |
| [12] | WANG JH, LIU YC, LEE SS, et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan[J]. Clin Infect Dis, 1998, 26(6):1434-1438. |
| [13] | FANG CT, LAI SY, YI WC, et al. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess[J]. Clin Infect Dis, 2007,45(3):284-293. |
| [14] | FANG CT, CHEN YC, CHANG SC, et al. Klebsiella pneumoniae meningitis: timing of antimicrobial therapy and prognosis[J]. QJM, 2000, 93(1):45-53. |
| [15] | LIN YT, SIU LK, LIN JC, et al. Seroepidemiology of Klebsiella pneumoniae colonizing the intestinal tract of healthy Chinese and overseas Chinese adults in Asian countries[J]. BMC Microbiol, 2012, 12:13. |
| [16] | KANG CI, KIM SH, BANG JW, et al. Community-acquired versus nosocomial Klebsiella pneumoniae bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance[J]. J Korean Med Sci, 2006, 21(5):816-822. |
| [17] | BRATU S, TOLANEY P, KARUMUDI U, et al. Carbapenemase-producing Klebsiella pneumoniae in Brooklyn, NY: molecular epidemiology and in vitro activity of polymyxin B and other agents[J]. J Antimicrob Chemother, 2005, 56(1):128-132. |
| [18] | SHIN SU, PARK CM, LEE Y, et al. Clinical and radiological features of invasive Klebsiella pneumoniae liver abscess syndrome[J]. Acta Radiol, 2013, 54(5):557-563. |
| [19] | FANG CT, LAI SY, YI WC, et al. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess[J]. Clin Infect Dis, 2007, 45(3):284-293. |
| [20] | QU TT, ZHOU JC, JIANG Y, et al. Clinical and microbiological characteristics of Klebsiella pneumoniae liver abscess in East China[J]. BMC Infect Dis, 2015, 15:161. |
| [21] | WANG JH, LIU YC, LEE SS, et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan[J]. Clin Infect Dis, 1998, 26(6):1434-1438. |
