【摘要】 目的探讨产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌院内肺部感染发生的危险因素及预后相关因素。方法对25例产ESBLs肺炎克雷伯菌院内肺部感染患者的临床资料作回顾性分析。结果本组25例病人在产ESBLs肺炎克雷伯菌分离前均使用过第三代头孢菌素,除1例外均合并有基础疾病。其中单独感染5例,混合感染20例,以混合一到二种病原菌为多,病原菌种类以真菌为主。无论是否混合感染,治疗产ESBLs肺炎克雷伯菌感染的住院时间均较长。混合感染的死亡率比单独感染要高且死亡率随着混合感染病原菌种类的增加而增高。产ESBLs肺炎克雷伯菌感染时,白细胞数量多者、年龄小者预后好。结论存在严重基础疾病且有应用第三代头孢菌素史的病人,要密切注意是否有产ESBLs肺炎克雷伯菌院内肺部感染。当存在产ESBLs肺炎克雷伯菌感染时,患者年龄、白细胞数、是否混合感染及其病原菌的种类就成为判断患者预后的重要相关因素。更多还原

【Abstract】 Objective To analyze the risk factors and prognosis related factors of nosocomial pulmonary infection caused by ESBLs producing Klebsiella pneumoniae. Methods To review and analyze the clinical data of 25 nosocomial pulmonary infected patients caused by ESBLs producing Klebsiella pneumoniae. Results Total of 25 patients had been treated by the third generation cephalosporin before ESBLs producing Klebsiella pneumoniae were isolated. 24 of them had basic disease. 5 of them were infected only by the ESBLs producing Klebsiella pneumoniae while the other 20 were mixed infection. There were one, two or three types of pathogens in one mixed infected patient. The most common pathogen was fungi.The length of stay was longer if one was infected by such bacteria. The mortality of mixed infection is higher and increasing with the number of the pathogen types. The prognosis is better in patient who had high leucocyte count and/or low age. Conclusion In patient who had severe basic disease and ever being treated with the third generation cephalosporin, the rate of nosocomial pulmonary infection caused by ESBLs producing Klebsiella pneumoniae is high. Once it was confirmed that such infection did exist, the age, amount of leucocyte, if it was mixed infection, and the type of pathogens were becoming important factors that could affect the patient’s prognosis.更多还原