- 期刊
Nosocomial ＂Klebsiella Pneumoniae＂ Bacteremia: Clinical Features and Antimicrobial Susceptibilities of Isolates
院內感染之＂Klebsiella pneumonia＂菌血症：臨床特色與其菌株之抗生素感受性
摘要
本研究為分析1997年7月至1998年6月間，在中國醫藥學院附設醫院診斷院內感染K.pneumoniae菌血症之24位成人病例。所有病人均有嚴重之潛在性及病，以肝硬化（29%）、糖尿病（25%）、及癌症（25%）最常見。臨床症後群包括原發性菌血症（63%），肺炎（25%），及腹腔內感染（12%）。K.pneumoniae感染之途徑有50%仍不明確。其中16名病人於菌血症發生時有放制中央靜脈導管，僅3名病例確認為中央靜脈導管相關之感染。病患中有17%為多發性菌血症。全不病例死亡率為58%，其中有46%死因與K.pneumoniae菌血症相關。以複迴歸分析發現，感染時有放制中央靜脈導管者與高APACHE II分數者可能預測高死亡率。所有菌株對ampicillin皆具有抗藥性，但均對imipenem具感受性。其他抗菌藥物之有效率分別為Moxalacram（96%），ceftazidime（71%），amoxicillin／calvulanic aci（67%），aztreonam（58%），ceftriaxone（58%），cefotaxime（58%），cefonicid（54%），cephalothin（54%），genramici（54%），及amikacin（54%）。適當的抗菌藥物如moxalacam及imipenem等，在治療多重抗藥性之K.pneumoniae感染時，可為優先考慮選擇之藥物。
並列摘要
From July 1997 through June 1998, 24 consecutive adult patients with nosocomial Klebsiella pneumoniae bacteremia were diagnosed at the China Medical College Hospital. Herein, we present the clinical features and the prognostic factors of the outcome in these 24 patients. All these patients had one or more underlying diseases including liver cirrhosis, diabetes mellitus and malignancy. Localized infections were noted in nine (37%) patients, including six with pneumonia, and three with intra-abdominal infection. Of the 15 (63%) patients with primary bacteremia, three met the criteria for catheter-related infection. The portal of entry was unknown in the remaining 12 patients. Of the 16 patients with central venous catheters in place at the onset of bacteremia, four of the six removed catheters were sent for tip culture, and three grew K. pneumoniae. The survival rate was significantly higher in patients whose catheters were removed than in those whose catheters remained (83% vs 10%, p=0.008). The overall mortality rate was 58% (14/24); 11 (46%) patients died of K. pneumoniae bacteremia. Mutivariate analysis demonstrated that patients with central venous catheters and high acute physiology and chronic health evaluation (APACHE) II scores had significantly higher risks for death. All isolates were susceptible to imipenem; 96% of the strains were susceptible to moxalactam, 71% to ceftazidime, 67% to amoxicillin/clavulanic acid, 58% to aztreonam, ceftriaxone and cefotaxime, 54% to cephalothin, gentamicin and amikacin; however, none was susceptible to ampicillin. In conclusion, to improve the outcome of patients with nosocomial K. pneumoniae bacteremia, early removal of the indwelling central venous catheter with tip culture is mandatory. Moxalactam and imipenem should be drugs of choice for the treatment of multi-drug resistant K. pneumoniae bacteremia.