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首页> 外文期刊>Surgical infections >Polymicrobial Bacteremia Involving Klebsiella pneumoniae in Patients with Complicated Intra-Abdominal Infections: Frequency, Co-Pathogens, Risk Factors, and Clinical Outcomes
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Polymicrobial Bacteremia Involving Klebsiella pneumoniae in Patients with Complicated Intra-Abdominal Infections: Frequency, Co-Pathogens, Risk Factors, and Clinical Outcomes

机译：复杂性腹腔内感染患者中涉及肺炎克雷伯菌的多菌性细菌血症：频率，共病原体，危险因素和临床结果

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Background: Klebsiella pneumoniae has gained notoriety because of its high antibiotic resistance and mortality. We compared the clinical features and outcomes of polymicrobial bacteremia involving K. pneumoniae (PBKP). Patients and Methods: A retrospective observational study of patients with polymicrobial and monomicrobial bacteremia involving K. pneumoniae from January 2012 to December 2016 was performed. The expression of resistance and virulence genes of 27 strains was also compared by polymerase chain reaction (PCR). Results: Among the polymicrobial group, the most common accompanying micro-organism was Escherichia coli. No differences in the expression of resistance and virulence genes was found among the 27 strains collected from the group. The analysis of the outcomes revealed that the patients with PBKP were more likely to have recurrent blood stream infections (p = 0.038), longer intensive care unit (ICU) lengths of stay (p = 0.043), and a higher total hospitalization cost (p = 0.045). However, no substantial differences in mortality were found between the two groups. The multivariable analysis revealed that a longer hospital stay prior to the onset of bacteremia (20 days) was an independent risk factor for PBKP (p = 0.034), and the Sequential Organ Failure Assessment (SOFA) score upon onset of infection (p = 0.013), the adequacy of source control (p 0.001), and iron supplementation (p = 0.003) were identified as independent predictors of mortality in patients with KP bacteremia. Conclusions: The development of septic shock and the concomitant use of iron supplementation are associated with higher mortality in patients with KP bacteremia, and PBKP did not increase the mortality of these patients, possibly because of the ability of K. pneumoniae to obscure the effects of other bacteria. Thus, adequate source control is more important than high-dose antibiotic therapy and is linked to higher survival.
机译：背景：肺炎克雷伯菌由于其高耐药性和高死亡率而臭名昭著。我们比较了涉及肺炎克雷伯菌（PBKP）的多菌血症的临床特征和结局。患者和方法：进行了一项回顾性观察研究，研究对象为2012年1月至2016年12月患有肺炎克雷伯菌的多微生物和单微生物菌血症的患者。还通过聚合酶链反应（PCR）比较了27个菌株的抗性和毒力基因的表达。结果：在微生物群中，最常见的伴随微生物是大肠杆菌。从该组收集的27株菌株中未发现抗性和毒力基因的表达差异。对结果的分析表明，PBKP患者更有可能再次出现血流感染（p = 0.038），重症监护病房（ICU）住院时间更长（p = 0.043）和总住院费用较高（p = 0.045）。然而，两组之间在死亡率上没有发现实质性差异。多变量分析显示，菌血症发作前住院时间较长（> 20天）是PBKP的独立危险因素（p = 0.034），感染发作后顺序器官衰竭评估（SOFA）评分（p = 0.013），源控制的充分性（p <0.001）和铁的补充（p = 0.003）被确定为KP菌血症患者死亡率的独立预测因子。结论：败血症性休克的发展和铁补充剂的使用与KP菌血症患者的死亡率较高相关，PBKP并未增加这些患者的死亡率，这可能是由于肺炎克雷伯菌能够掩盖肺炎的影响。其他细菌。因此，适当的源头控制比大剂量抗生素治疗更为重要，并与更高的生存率相关。

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