Clinical Research Of Bacteremia Between Escherichia Coli And Klebsiella Pneumonia

Background and objective:Bacteremia is a serious systemic infectious disease with high morbidity and mortality.In recent years,E.coli bacteria has become the most common pathogen causing bacteremia in the world,among which E.coli(44.4%)occupies the first place,followed by Klebsiella(31.7%).In recent years,carbapenems have become the first choice for the treatment of drug-resistant gram-negative bacteria infection.However,subsequently the detection rate of the carbapenems-resistant Enterobacter(CRE)is rapidly increasing,which has become a difficult problem in the current clinical treatment.Therefore,understanding the clinical characteristics and drug resistance rate of E.coli and Klebsiella pneumoniae bacteremia can improve the prognosis and avoid antibiotics abuse.There are great differences between E.coli and Klebsiella pneumoniae in clinical manifestations,laboratory examination,antibiotic selection and some other aspects,but a few of studies on differences between E.coli and Klebsiella pneumoniae bloodstream infection at home and abroad.By retrospective analyzing the clinical data of E.coli and Klebsiella pneumonia bacteria bacteremia patients,this research compares clinical characteristics,resistance and risk factors of prognosis between these patients,guiding early identification of pathogenic bacteria,early application of antibiotics,early judgement of prognosis,in order to reduce the fatality rate.Material and methods:From January 2011 to September 2017,clinical data of patients aged at least 15 years who were hospitalized in shengjing hospital affiliated to China Medical University and were associated with E.coli or Klebsiella pneumoniae bacteremia.Clinical data of 868 patients with E.coli and 403 patients with Klebsiella pneumoniae bacteremia were analyzed.In the first part,all cases were divided into E.coli bacteremia group and Klebsiella pneumoniae bacteremia group according to blood culture results,and the differences between the two groups in general clinical data,laboratory examination,bacterial culture,drug resistance and prognosis were compared and analyzed.In the second part,some patients with incomplete laboratory examination results were excluded.According to the prognosis of the patients,the patients who were ordered to leave the hospital were classified as improved group,and the patients who died were classified as poor prognosis group,and the risk factors affecting poor prognosis were analyzed.Results:1.Female patients,gynecological surgery,biliary tract,pancreatic infection,and urinary tract infection are independent risk factors for E.coli bacteremia(P<0.01),while male patients,combined with hypertension and liver abscess,and the use of ventilator are risk factors for klebsiella pneumoniae bacteremia(P<0.05).2.There was a significant difference in the distribution of e E.coli and Klebsiella pneumoniae bacteremia in the department(P < 0.01).The detection rate of E.coli was higher in the department of obstetrics and gynecology and nephrology,while the detection rate of Klebsiella pneumoniae in the department of ICU,respiratory department and surgical department was significantly higher than that of E.coli(P < 0.01).3.The detection rate of ESBL strain in E.coli bacteremia in our hospital was 61.6%(381/695);The detection rate of ESBL in Klebsiella pneumoniae bacteremia was 23.8%(98/336),and the difference between the two groups was statistically significant(P < 0.001).From 2011 to 2017,8 cases(0.9%)of carbapenems-resistant E.coli and 13 cases(3.2%)of Klebsiella pneumoniae were cultured in our hospital,and the difference between two groups was statistically significant(P < 0.001).In this study,it was found that the drug resistance rate of levofloxacin to CRE E.coli was 87.9%,while that to Klebsiella pneumoniae was 30.8%,the difference was statistically significant(P < 0.011).4.The independent risk factors for poor prognosis were different between E.coli and Klebsiella pneumoniae.Combined hematologic malignancy and gastric tube use are independent risk factors for poor prognosis of E.coli bacteremia.Liver cirrhosis,ventilator use and Klebsiella pneumoniae bacteremia were associated with poor prognosis(P<0.01).Septic shock is a common risk factor for poor prognosis in E.coli and Klebsiella pneumoniae patients(P<0.01).Conclusion:The risk factors of Klebsiella pneumoniae and E.coli bacteremia were different,and there were significant differences in the distribution in different wards,sensitivity to drugs and drug resistance.The drug resistance rate of carbapenems in Klebsiella pneumoniae was significantly higher than that of E.coli.The independent risk factors for poor prognosis were different between E.coli and Klebsiella pneumoniae.