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目的 了解老年人克雷伯菌属肺部感染的临床特征和细菌耐药性。方法 收集我院 2 0 0 0～ 2 0 0 1年老年克雷伯菌属肺部感染 6 1例 ,从病史、症状、体征、胸部X线检查、治疗和转归等方面分析老年克雷伯菌属所致肺部感染的临床特征。用纸片法检测克雷伯菌属对阿米卡星等 12种抗生素的体外药敏检测并测 β 内酰胺酶 (ESBLs)。结果 94 .9%的患者有基础疾病 ,临床症状以发热、咳嗽、咳痰为主 ,胸部X线以含有空气支气管症的大叶肺实变 (2 6 .2 % )、小叶浸润 (5 9.9% )和肺脓肿 (14 .8% )为主要病变 ,10例 (16 .4 % )叶间隙成弧性下坠形成克雷伯菌属肺感染的特征X线征象。 6 1例患者中 ,产ESBLs菌属占 31.1% ,对多种抗生素交叉耐药 ,对亚胺培南和部分含ESBLs抑制剂的复合抗生素敏感。结论 老年人克雷伯菌属肺感染患者多有基础疾病 ,临床表现无特异性。诊断依靠病原菌检测并结合临床和X线检查 ,治疗应根据药敏测定 ,选择敏感抗菌素。对产ESBLs克雷伯菌属引起肺部感染者 ,应用亚胺培南或部分含 β 内酰胺酶抑制剂的复合物 ,或者选用药敏测定显示敏感的药物。
Objective To understand the clinical characteristics and bacterial resistance of Klebsiella pneumoniae infection in the elderly. Methods A total of 61 elderly patients with Klebsiella pneumoniae were collected from 2000 to 2001 in our hospital. Elderly patients were analyzed for Klebsiella pneumoniae from history, symptoms, signs, chest X-ray examination, treatment and prognosis. Clinical characteristics of lung infection caused by bacteria. In vitro detection of 12 antibiotics, such as amikacin, by Klebsiella spp. And beta-lactamases (ESBLs) were determined by disk-blot assay. Results 94.9% of the patients had underlying diseases. The main clinical symptoms were fever, cough and expectoration. The chest radiographs were confirmed by airway bronchiectasis (26.2%), lobular infiltration (59.9% %) And lung abscess (14.8%) as the main lesion, and 10 cases (16.4%) of the leaf interspaces arc down to form characteristic X-ray signs of Klebsiella pneumoniae infection. Among 61 patients, 31.1% were ESBLs-producing bacteria, resistant to multiple antibiotics and sensitive to antibiotics combined with imipenem and some ESBLs-containing inhibitors. Conclusion The elderly patients with Klebsiella pneumonia have more underlying diseases, clinical manifestations of non-specific. Diagnosis depends on pathogen detection combined with clinical and X-ray examination, the treatment should be based on susceptibility testing, the choice of sensitive antibiotics. In patients with ESBLs-producing Klebsiella pneumoniae infection, the application of imipenem or β-lactamase inhibitor-containing complex, or the choice of drug sensitivity test showed that the drug is sensitive.