【摘要】 目的比较产和非产超广谱β内酰胺酶(ESBLs)肺炎克雷伯杆菌(KP)的医院及社区感染患者的临床分布特征及菌株耐药性差异,为临床诊疗提供依据。方法采用回顾性调查的方法,收集2017年1月1日至2018年6月30日在我院检出KP感染菌株的患者临床特征和耐药情况,运用卡方检验或Fisher确切概率法比较产和非产ESBLs-KP的分布及耐药性差异。结果共检出KP感染菌株334株,产ESBLs-KP的检出率为24.85%(83/334)。医院与社区感染的产ESBLs-KP检出率差异无统计学意义(31.25%vs. 22.27%,χ~2=2.955,P=0.086)。产ESBLs-KP的检出率女性高于男性,差异有统计学意义(32.32%vs. 21.70%,χ~2=4.208,P=0.040)。产ESBLs-KP在<18岁、18～45岁、45～60岁和≥60岁各组的检出率差异均无统计学意义。KP感染部位的前三位依次均为下呼吸道、泌尿道、菌血症。医院感染产ESBLs-KP在各部位、各科室的分布均无明显差异。社区感染产ESBLs-KP在各部位、各科室的分布均有明显差异,其中感染部位前两位为泌尿道(37.74%)、皮肤软组织(30.77%);感染科室前两位为泌尿外科(40.00%)、呼吸内科(38.10%)。产ESBLs-KP比非产ESBLs-KP对16种抗生素的耐药率较高,其差异有统计学意义(P<0.05);产ESBLs-KP与非产ESBLs-KP的医院和社区感染对常见抗生素的耐药率差异均无统计学意义(P>0.05)。结论医院和社区感染产ESBLs-KP的检出率和耐药率均较高,应加强临床抗菌药物使用管理,对产ESBLs-KP感染病例实时监控。对女性和社区泌尿道感染KP等患者,应提高警惕,加强院感防控,减少交叉感染。更多还原

【Abstract】 Objective To compare the clinical characteristics of patients with nosocomial and community infections with extended-spectrum beta-lactamase-containing Klebsiella pneumoniae(ESBL-KP) and non-ESBL-KP so as to improve clinical diagnosis and treatment outcomes. Methods This retrospective study determined the clinical features of patients with nosocomial and community infections with KP who were admitted to our hospital from January 1 st, 2017 to June 30 th, 2018. The chi-square test or Fisher’s exact probability method were used to compare different groups.Results We identified 334 strains of KP, and 83(24.9%) of them strains were EBSL-KP. The percentages of ESBL-KP infections among those with nosocomial and community infections were similar(31.25% vs. 22.27%, χ~2=2.955, P=0.086).Significantly more females than males had ESBL-KP infections(32.32 vs. 21.70%, χ~2=4.208, P=0.040). The percentages of ESBL-KP infections were similar among <18 years-old group, 18 to 45 years-old group, 45 to 60 years-old group, and ≥60 years-old group. The three major locations of KP infections were the lower respiratory tract, urinary tract, and bloodstream(bacteremia). Among nosocomial KP infections, there were no significant differences in the percentages of ESBL-KP infections at different sites, nor in the hospital departments where patients were treated; among community KP infections, there were significant differences in the percentages of ESBLs-KP infections at different sites, and in the hospital departments where patients were treated. For community KP infections, the two most common infection sites were the urinary tract(37.74%) and the skin and soft tissue(30.77%), and most patients were treated in the urology department(40.00%) and respiratory medicine department(38.10%). ESBL-KP isolates had greater resistance than nonEBSL-KP isolates to 16 tested antibiotics(P<0.05). There were no statistically significant differences in the percentages of nosocomial infections and community infections among those with ESBL-KP and among those with non-ESBL-KP(P>0.05). Conclusions Our population have high rates of nosocomial and community KP infections and of infections with ESBL-KP. It is necessary to strengthen the management and clinical use of antibiotics and to provide real-time surveillance of KP infections, especially for patients with ESBL-KP infections. Increased vigilance is required for KP infections of females and community KP infections to improve control of nosocomial infections and reduce the prevalence of cross-infections.更多还原