论文部分内容阅读
目的探讨肺炎克雷伯菌血流感染的临床特点、治疗方案和预后。方法对诸暨市人民医院2014年3月-2015年9月诊断为肺炎克雷伯菌血流感染的住院患者临床资料进行回顾性分析。结果 66例肺炎克雷伯菌血流感染患者平均年龄64.6岁,检出前平均住院5.7d。13例(19.7%)合并有其他细菌感染,49例(74.2%)合并其他系统感染。肺炎克雷伯菌血流感染多见于糖尿病(33.3%)、实体肿瘤(30.3%)等免疫力低下疾病,最常见于肝胆外科(24.2%)、内分泌科(16.7%)等科室。患者预后好转47例(71.2%),APACHEⅡ评分为13.78±4.33;死亡19例(28.8%),APACHEⅡ评分为21.10±7.45,两组评分差异有统计学意义(P<0.05)。合并其他感染状况与合并神经系统疾病状况病死率更高(P<0.05)。结论肺炎克雷伯菌血流感染多见于糖尿病、实体肿瘤等免疫力低下的危重疾病患者,多发生在医院内环境的外科手术操作的科室,容易合并其他系统感染。APACHEⅡ评分可作为判断肺炎克雷伯菌血流感染预后的重要指标。控制其他感染情况可有助于临床防控肺炎克雷伯菌血流感染,改善其预后。
Objective To investigate the clinical characteristics, treatment and prognosis of Klebsiella pneumoniae bloodstream infection. Methods The clinical data of hospitalized patients diagnosed as Klebsiella pneumoniae infection from March 2014 to September 2015 in Zhuji People’s Hospital were analyzed retrospectively. Results The average age of 66 cases of Klebsiella pneumoniae infection was 64.6 years and the average hospitalization time was 5.7 days. Thirteen (19.7%) patients had other bacterial infections, while 49 (74.2%) had other systemic infections. Klebsiella pneumoniae bloodstream infection more common in diabetes (33.3%), solid tumors (30.3%) and other immunocompromised diseases, the most common in hepatobiliary surgery (24.2%), Department of Endocrinology (16.7%) and other departments. The prognosis of patients improved in 47 cases (71.2%), APACHEⅡscore of 13.78 ± 4.33, death in 19 cases (28.8%) and APACHEⅡscore of 21.10 ± 7.45. There was significant difference between the two groups (P <0.05). Patients with other infections and those with neurological disorders had a higher case-fatality rate (P <0.05). Conclusion Klebsiella pneumoniae bloodstream infections are more common in critically ill patients with low immunity, such as diabetes and solid tumors. They occur in the departments of surgical operation in the hospital’s internal environment and are easily combined with other systemic infections. APACHE Ⅱ score can be used as an important indicator of prognosis of Klebsiella pneumoniae infection. Control of other infections can help clinical prevention and treatment of Klebsiella pneumoniae bloodstream infection and improve its prognosis.