Department of Internal Medicine, Seoul Metropolitan Bukbu Hospital, Seoul, Korea.
J Korean Med Sci. 2013 Aug;28(8):1187-93. doi: 10.3346/jkms.2013.28.8.1187. Epub 2013 Jul 31.
The prevalence of antibiotic resistance is higher in patients undergoing renal replacement therapy (RRT) than in patients who did not undergo RRT. We investigated the presence of KP (Klebsiella pneumoniae) in patients who underwent RRT. All data were collected retrospectively by accessing patient medical records from 2004 to 2011 for the culture results of all patients who were positive for KP. We grouped the patients by the presence of extended-spectrum β-lactamase (ESBL) into a KP ESBL(-) group (KP[-]) and a KP ESBL(+) group (KP[+]). In total, 292 patients (23.1%) were in the KP(+) group, and 974 patients (76.9%) were in the KP(-) group. A greater percentage of KP(+) was found in patients who underwent RRT (7.5%) than in patients who did not undergo RRT (3.2%) (OR, 2.479; 95% CI,1.412-4.352). A Cox's hazard proportional model analysis was performed, and for patients with pneumonia, the risk of KP(+) was 0.663 times higher in patients who had lower albumin levels, 2.796 times higher in patients who had an inserted Levin tube, and 4.551 times higher in patients who underwent RRT. In conclusion, RRT can be a risk factor for KP(+) in patients with pneumonia.
在接受肾脏替代治疗（RRT）的患者中，抗生素耐药性的发生率高于未接受 RRT 的患者。我们调查了接受 RRT 的患者中肺炎克雷伯菌（KP）的存在情况。所有数据均通过回顾性访问 2004 年至 2011 年所有阳性 KP 患者的病历记录收集。我们将患者按是否存在超广谱β-内酰胺酶（ESBL）分为肺炎克雷伯菌 ESBL（-）组（KP[-]）和肺炎克雷伯菌 ESBL（+）组（KP[+]）。共有 292 名患者（23.1%）为 KP（+）组，974 名患者（76.9%）为 KP（-）组。在接受 RRT 的患者中，KP（+）的比例（7.5%）高于未接受 RRT 的患者（3.2%）（OR，2.479；95%CI，1.412-4.352）。进行 Cox 比例风险模型分析，对于肺炎患者，白蛋白水平较低的患者发生 KP（+）的风险是白蛋白水平正常患者的 0.663 倍，留置 Levin 管的患者风险是无 Levin 管患者的 2.796 倍，接受 RRT 的患者风险是未接受 RRT 的患者的 4.551 倍。总之，RRT 可能是肺炎患者发生 KP（+）的一个危险因素。
