摘要
目的探讨肺炎克雷伯菌血流感染患者炎症指标诊断价值、不同预后临床特征及药敏试验的差异。方法回顾性收集2018年1月—2023年5月肺炎克雷伯菌血培养阳性患者166例为肺炎克雷伯菌阳性组,血培养阴性患者100例为血培养阴性组,通过受试者工作特征曲线(receiver operating characteristic curve,ROC)探讨炎症指标对肺炎克雷伯菌血流感染的诊断价值;分析C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)在肺炎克雷伯菌血流感染与非肺炎克雷伯菌血流感染的差异;根据预后情况将肺炎克雷伯菌血流感染166例患者分为好转组105例和预后不良组61例,分析不同预后临床特征、感染部位、经验抗菌药物使用及药物敏感性等差异。结果血培养肺炎克雷伯菌阳性组中性粒细胞百分比(Z=-3.645,P<0.001)、CRP(Z=-6.809,P<0.001)、PCT(Z=-8.214,P<0.001)明显高于血培养阴性组,差异有统计学意义;CRP、PCT诊断肺炎克雷伯菌血流感染ROC曲线下面积(AUC)分别是0.755、0.849;肺炎克雷伯菌、其他常见阴性杆菌、常见阳性球菌及念珠菌引起的血流感染时CRP(H=20.902,P<0.001)、PCT(H=33.521,P<0.001)水平升高程度不完全一致,差异有统计学意义。预后不良组体温、白蛋白、血红蛋白及住院天数低于好转组,差异具有统计学意义(P<0.05),而在侵入性操作、器官衰竭、休克及抢救情况高于好转组,差异具有统计学意义(P<0.05);预后不良组合并感染主要为呼吸系统占60.7%(37/61);好转组合并感染主要来源于呼吸系统占49.5%(52/105),其次肝胆系统占34.3%(36/105)。不同的感染部位培养出来的致病菌主要为肺炎克雷伯菌。好转组经验治疗最常用的药物是氟喹诺酮类,使用率高达76.2%(80/105),其次是β-内酰胺酶抑制剂复合制剂为68.6%(72/105),两种药物明显高于预后不良组(P<0.05);碳青霉烯类药物是预后不良组首选药物,使用率高达62.3%(38/61),明显高于好转组(P<0.05)。药敏试验结果预后不良组喹诺酮类药物环丙沙星耐药率高达40.98%(25/61)、左氧氟沙星37.7%(23/61),好转组环丙沙星耐药率22.86%(24/105)、左氧氟沙星32.38%(34/105)。其余药物耐药率较低且两组未见明显差异(P>0.05)。结论PCT、CRP对诊断肺炎克雷伯菌血流感染有一定价值,同时对鉴别革兰阴性菌与革兰阳性菌、念珠菌血流感染有一定的参考意义;预后不良患者血流感染主要来源可能为呼吸系统,好转患者血流感染来源可能主要为呼吸系统和肝胆系统;药敏试验发现喹诺酮类药物耐药率最高,而喹诺酮类药物常作为临床经验治疗药物,可能会出现治疗无效情况;在经验治疗过程中预后不良组更倾向使用高级药物碳青霉烯类。
Objective To analyze the diagnostic value of inflammatory markers,clinical characteristics of patients with different prognoses,and variations in antimicrobial susceptibility testing for Klebsiella pneumoniae bloodstream infection.Methods This study involved 166 patients with positive blood cultures for Klebsiella pneumoniae from January 2018 to May 2023 as the Klebsiella pneumoniae-positive group,and 100 patients with negative blood culture results as the negative group.The diagnostic value of inflammatory markers for Klebsiella pneumoniae bloodstream infection was evaluated through receiver operating characteristic(ROC)curve.The differences in C-reactive protein(CRP)and procalcitonin(PCT)levels between Klebsiella pneumoniae bloodstream infections and non-Klebsiella pneumoniae bloodstream infections were analyzed.According to the prognoses,166 patients with Klebsiella pneumoniae bloodstream infection were divided into two groups:favorable outcome group(105 cases)and adverse outcome group(61 cases).Clinical features,infection sites,empirical use of antibiotics,and antimicrobial susceptibility were compared between the patients with different outcomes.Results The percentage of neutrophils(Z=-3.645,P<0.001),CRP level(Z=-6.809,P<0.001),and PCT level(Z=-8.214,P<0.001)were significantly higher in the Klebsiella pneumoniae-positive group than in the negative group.The area under the ROC curve(AUC)values for CRP and PCT in diagnosing Klebsiella pneumoniae bloodstream infection were 0.755 and 0.849,respectively.There were variations in CRP(H=20.902,P<0.001)and PCT(H=33.521,P<0.001)levels among patients with bloodstream infection caused by Klebsiella pneumoniae,other common negative bacilli,common positive cocci,or Candida.The body temperature,albumin level,hemoglobin level,and length of hospital stay in the adverse outcome group were lower than those in the favorable outcome group(P<0.05).Besides,the incidence of invasive operation,organ failure,shock,and rescue were also lower in the adverse outcome group(P<0.05).In the adverse outcome group,co-infections mainly involved respiratory infections,accounting for 60.7%(37/61).Respiratory infections(49.5%,52/105)were also the predominant co-infections in the favorable outcome group,followed by hepatobiliary infections(34.3%,36/105).The pathogenic bacteria cultured from different infection sites were mainly Klebsiella pneumoniae.In the favorable outcome group,fluoroquinolones were the most commonly used medications for empirical therapy,with a usage rate of 76.2%(80/105),followed by β-lactamase inhibitor complex preparations(68.6%,72/105),the usage rate of which were significantly higher than those in the adverse outcome group(P<0.05).Carbapenems were the preferred drugs for the adverse outcome group,with a usage rate of up to 62.3%(38/61),which was significantly higher than that in the favorable outcome group(P<0.05).The adverse outcome group showed high resistance rates to ciprofloxacin(40.98%,25/61)and levofloxacin(37.7%,23/61),while the resistance rates were 22.86%(24/105)and 32.38%(34/105)in the favorable outcome group.The resistance rates to other drugs were low and there was no significant difference between the two groups(P>0.05).Conclusions PCT and CRP have certain value in diagnosing bloodstream infections caused by Klebsiella pneumoniae,and have certain reference significance for differentiating bloodstream infections caused by Gram-negative bacteria,Gram-positive bacteria,and Candida species.The source of bloodstream infection in patients with adverse outcome may be the respiratory system,while in patients with favorable outcome,the main sources of bloodstream infection may be the respiratory and hepatobiliary systems.Antimicrobial susceptibility testing reveals the highest resistance rate to fluoroquinolones.Given their frequent use in empirical therapy,this may lead to treatment failure.Notably,carbapenems are more commonly administered as empirical antibiotics in the adverse outcome group.
作者
潘美秀
蒙秀坚
林伟健
麦莹莹
毛得斌
Pan Meixiu;Meng Xiujian;Lin Weijian;Mai Yingying;Mao Debin(Department of Medical Laboratory,Wuzhou Red Cross Hospital,Wuzhou 543002,China;Medical Technology College,Wuzhou Medical College,Wuzhou 543002,China)
出处
《中华微生物学和免疫学杂志》
北大核心
2025年第8期649-656,共8页
Chinese Journal of Microbiology and Immunology
基金
广西高校中青年教师科研基础能力提升项目(2022KY1930)
广西壮族自治区卫生健康委员会自筹课题(Z-D20251494)。
关键词
肺炎克雷伯菌
C反应蛋白
降钙素原
经验治疗
氟喹诺酮
药敏实验
血流感染
Klebsiella pneumoniae
C-reactive protein
Procalcitonin
Empirical treatment
Fluoroquinolone
Drug susceptibility testing
Bloodstream infection
