产超广谱β-内酰胺酶肺炎克雷伯菌医院获得性菌血症。危险因素及临床结局。

Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae hospital acquired bacteremia. Risk factors and clinical outcome.

作者信息

Panhotra Bodh R, Saxena Anil K, Al-Ghamdi Ali M

机构信息

Department of Microbiology and Infection Control Officer, King Fahad Hospital, Al-Hofuf, Al-Hasa 31982, Kingdom of Saudi Arabia.

出版信息

Saudi Med J. 2004 Dec;25(12):1871-6.

PMID:15711657

Abstract

OBJECTIVE

To study the risk factors and clinical outcome in patients having extended-spectrum beta-lactamase producing (ESBL) Klebsiella pneumoniae (K. pneumoniae) hospital acquired bacteremia.

METHODS

The study was conducted at 500 bedded King Fahad Hospital and Tertiary Care Center, Al-Hofuf, Al-Hasa, Eastern Province of Saudi Arabia. Retrospectively infection control and microbiology records of patients having hospital acquired K. pneumoniae bacteremia during July 2001 to July 2003 were reviewed. Data on age, gender, location, onset of bacteremia, hospital stay after onset of bacteremia, prior antibiotic therapy, comorbid conditions and clinical outcome were recorded.

RESULTS

During 2 years of study period 26 patients developed hospital acquired K. pneumoniae bacteremia, out of them 10 patients had bacteremia due to ESBL producing strains. Extended-spectrum beta-lactamase producing K. pneumoniae bacteremia was significantly higher among patients of less than 65 years of age (p=0.004). Klebsiella pneumoniae bacteremia was more common (12/26, 46.1%) among diabetic patients and 8/12 had ESBL K. pneumoniae bacteremia. (p=0.02). Invasive devices (urinary and vascular catheters) were more commonly observed among patients having ESBL K.pneumoniae bacteremia (p=0.004, 0.001). Significantly higher number (9/10) of patients with ESBL K.pneumoniae bacteremia received prior third generation cephalosporins (p=0.001). Extended-spectrum beta-lactamase K. pneumoniae hospital acquired bacteremia had significantly longer hospital stay and higher mortality (p=0.0001).

CONCLUSION

Elderly age, diabetes, invasive devices and prior third generation cephalosporin therapy are the major risk factors for hospital acquired ESBL K.pneumoniae bacteremia, leading to significantly higher mortality and prolonged hospitalization. Infection control measures should be aggressively followed to prevent such infections among these high risk patients.

摘要

目的

研究产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌所致医院获得性菌血症患者的危险因素及临床结局。

方法

本研究在沙特阿拉伯东部省胡富夫市哈萨地区拥有500张床位的法赫德国王医院及三级护理中心开展。回顾性分析2001年7月至2003年7月期间医院获得性肺炎克雷伯菌菌血症患者的感染控制及微生物学记录。记录患者的年龄、性别、感染部位、菌血症发病时间、菌血症发病后的住院时间、既往抗生素治疗情况、合并症及临床结局。

结果

在2年的研究期间，26例患者发生医院获得性肺炎克雷伯菌菌血症，其中10例患者的菌血症由产ESBL菌株引起。年龄小于65岁的患者中产ESBL肺炎克雷伯菌菌血症的发生率显著更高（p = 0.004）。肺炎克雷伯菌菌血症在糖尿病患者中更为常见（12/26，46.1%），其中8/12为产ESBL肺炎克雷伯菌菌血症（p = 0.02）。在产ESBL肺炎克雷伯菌菌血症患者中更常观察到侵入性装置（尿管和血管导管）（p = 0.004，0.001）。产ESBL肺炎克雷伯菌菌血症患者中接受过第三代头孢菌素治疗的比例显著更高（9/10）（p = 0.001）。产ESBL肺炎克雷伯菌医院获得性菌血症患者的住院时间显著更长，死亡率更高（p = 0.0001）。