2001-2008 年台湾地区肺炎克雷伯菌血流感染性社区获得性肺炎的临床和微生物学特征
Bacteremic community-acquired pneumonia due to Klebsiella pneumoniae: clinical and microbiological characteristics in Taiwan, 2001-2008.
机构信息
Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
出版信息
BMC Infect Dis. 2010 Oct 25;10:307. doi: 10.1186/1471-2334-10-307.
BACKGROUND
Klebsiella pneumoniae is the major cause of community-acquired pyogenic infections in Taiwan. This retrospective study evaluated the clinical and microbiological characteristics of bacteremic community-acquired pneumonia due to K. pneumoniae in Taiwanese adults.
METHODS
The clinical characteristics of bacteremic community-acquired pneumonia (CAP) in adults due to K. pneumoniae were compared to those of adults with bacteremic CAP due to Streptococcus pneumoniae at a tertiary medical center in Taiwan from 2001-2008. Risk factors for mortality of bacteremic CAP due to K. pneumoniae were analyzed. All clinical isolates of K. pneumoniae were examined for capsular serotypes, hypermucoviscosity phenotype, aerobactin and rmpA gene.
RESULTS
K. pneumoniae was the dominant cause of bacteremic CAP and was associated with a more fulminant course and a worse prognosis than bacteremic CAP due to Streptococcus pneumoniae. Initial presentation with septic shock and respiratory failure were independent risk factors for both early and total mortality. Serotype K1 and K2 comprised around half of all isolates. There were no significant differences in the clinical characteristics of patients with bacteremic CAP due to K1/K2 and non-K1/K2 isolates. Hypermucoviscosity phenotype as well as the aerobactin and rmpA genes were highly prevalent in the K. pneumoniae isolates.
CONCLUSIONS
K. pneumoniae continued to be the dominant cause of bacteremic CAP in Taiwanese adults during 2001-2008. Initial presentation with septic shock and respiratory failure were independent risk factors for both early and total mortality from K. pneumoniae bacteremic CAP. Serotypes K1/K2 comprised around half of all isolates, but did not predispose patients to a poor clinical outcome. Physicians should be aware of the poor prognosis of any patient with bacteremic K. pneumoniae CAP and monitor these patients more closely.
背景
肺炎克雷伯菌是导致台湾地区社区获得性化脓性感染的主要原因。本回顾性研究评估了台湾成年人社区获得性肺炎（CAP）合并肺炎克雷伯菌菌血症的临床和微生物学特征。
方法
在台湾的一家三级医疗中心，将成人社区获得性肺炎（CAP）合并肺炎克雷伯菌菌血症的临床特征与成人社区获得性肺炎（CAP）合并肺炎链球菌菌血症的临床特征进行比较。分析肺炎克雷伯菌菌血症合并 CAP 患者死亡的危险因素。对所有肺炎克雷伯菌临床分离株进行荚膜血清型、高黏液表型、aerobactin 和 rmpA 基因检测。
结果
肺炎克雷伯菌是导致菌血症性 CAP 的主要原因，与菌血症性 CAP 相比，肺炎克雷伯菌合并 CAP 患者的病情更为严重，预后更差。发病时出现感染性休克和呼吸衰竭是早期和总死亡率的独立危险因素。血清型 K1 和 K2 约占所有分离株的一半。菌血症性 CAP 患者中，K1/K2 型和非 K1/K2 型分离株的临床特征无显著差异。高黏液表型以及 aerobactin 和 rmpA 基因在肺炎克雷伯菌分离株中高度流行。
结论
2001-2008 年，肺炎克雷伯菌仍是台湾成年人菌血症性 CAP 的主要病原体。发病时出现感染性休克和呼吸衰竭是肺炎克雷伯菌菌血症合并 CAP 患者早期和总死亡率的独立危险因素。血清型 K1/K2 约占所有分离株的一半，但不会导致患者临床预后不良。医生应该意识到任何菌血症性肺炎克雷伯菌 CAP 患者的预后较差，并密切监测这些患者。
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