变栖克雷伯菌感染患者的临床特征

Clinical characteristics of patients with Klebsiella variicola infection

摘要:

目的 研究变栖克雷伯菌感染患者的临床特征, 为临床该病原菌的防控提供理论依据。 方法 回顾性收集2013年1月—2018年7月某医院临床分离经全基因组学测序鉴定为变栖克雷伯菌感染患者70例, 随机选取同期肺炎克雷伯菌感染患者70例作为对照, 分析两组患者的临床资料。 结果 70例变栖克雷伯菌感染患者年龄1d~95岁, 中位年龄51岁, 其中1岁以内的婴儿期患者6例(8.6%); 基础疾病主要有心血管疾病(16例, 22.9%), 其次是糖尿病(11例, 15.7%)和肿瘤(9例, 12.6%); 感染部位主要来自呼吸系统(34例, 48.6%)、血流(8例, 11.4%)和腹腔内(8例, 11.4%); 因接受过肿瘤放射和/或化学治疗、糖皮质激素和/或免疫抑制剂治疗而导致免疫力低下或抑制的患者20例(28.6%)。变栖克雷伯菌对常见抗菌药物耐药率较低(均 < 40%), 变栖克雷伯菌对抗菌药物的耐药率均低于肺炎克雷伯菌(均P < 0.001)。 结论 变栖克雷伯菌感染患者临床特征与肺炎克雷伯菌感染类似, 但需警惕该菌在婴儿及免疫力低下人群的流行传播。变栖克雷伯菌目前耐药率较低, 但仍需规范临床合理使用抗菌药物, 以防耐药性菌株的产生。

Abstract:

Objective To investigate the clinical characteristics of patients with Klebsiella variicola (K. variicola) infection, and provide theoretical basis for the prevention and control of the pathogen in clinical practice. Methods 70 patients infected with K. variicola identified by whole-genome sequencing in a hospital between January 2013 and July 2018 were collected retrospectively. 70 patients with Klebsiella pneumoniae (K. pneumoniae) infection during the same period were randomly selected as control. Clinical data of two groups were analyzed. Results 70 patients with K. variicola infection were aged 1 day-95 years, median age was 51 years old, 6 (8.6%) of whom were infants less than 1 year old. The underlying diseases were mainly cardiovascular diseases (16, 22.9%), followed by diabetes mellitus (11, 15.7%) and tumor (9, 12.6%). The main infection sites were respiratory system (34, 48.6%), blood stream (8, 11.4%) and intra-abdominal cavity (8, 11.4%). 20 patients (28.6%) were with low or suppressed immunity due to tumor radio-/chemotherapy, glucocorticoid or immunosuppressive therapy. Resistance rates of K. variicola to commonly used antimicrobial agents were low (all < 40%), and lower than that of K. pneumoniae (all P < 0.001). Conclusion Clinical characteristics of patients with K. variicola infection are similar to patients with K. pneumoniae infection. It is necessary to be alert to the epidemic transmission of this bacteria in infants and population with low immunity. At present, antimicrobial resistance rate of K. variicola is low, but it is still necessary to standardize clinical rational use of antimicrobial agents, so as to prevent the emergence of antimicrobial resistant strains.