| Background: Hospital infection is the most important risk factor which affects the patient's safety and treatment.With the widespread use of antibiotics,drug-resistant strains are increasing fast.The control of hospital infection is becoming increasingly difficult.Respiratory tract infection is one of the most infectious diseases in clinical.It ranks first among the causes of death from all infectious diseases.Lower respiratory tract infection(LRTI)ranks second in the incidence of hospital infection.The mortality rate is 30-70%.It is an important reason for the failure of the original disease treatment and the aggravation of the economic burden.Since 1960 s,gram negative bacteria have become the major pathogens of hospital infection and LRTI.Objective: By comparing the LRTI's rate of composition and its drug-resistance features by Klebsiella pneumoniae and Escherichia coli in the respiratory intensive care unit(RICU)and general wards,to seek the most effective treatment plan for the two kinds of bacteria.Methods: The subjects were the patients who diagnosed with LRTI from RICU and general wards of respiration in the First Affiliated Hospital of Suzhou University from January 2013 to June 2016.The subjects were grouped in different wards.Bacteriological results were obtained from sputum specimens,specimens from lower respiratory tract secretion brushings or bronchoalveolar washings(LRT-SB-BW),and blood specimens.A retrospective analysis was made on the data of the specimens from LRTI patients.The related data include their source composition,bacterial composition and drug sensitivity of commonly used antibiotics.Results:(1)There were no statistically significant differences in the constituent ratio of two Enterobacter species between Klebsiella pneumoniae and Escherichia coli from the specimens just like sputum specimens,LRT-SB-BW specimens,and blood specimens in RICU and general wards.(P>0.05).(2)The detection rate of Klebsiella pneumoniae was 80.7% in RICU,and 19.3% for Escherichia coli.The detection rate of Klebsiella pneumoniae just was 80.7% in general wards,while that of Escherichia coli was 19.3%.The detection rate of Klebsiella pneumoniae was significantly higher than that of Escherichia coli.(3)There was no significant difference in the constituent ratio of two common Enterobacteriaceae,Klebsiella pneumoniae and Escherichia coli between RICU and general wards(P>0.05).(4)There was no statistic difference in the resistance rate of Klebsiella pneumoniae between RICU and general wards.The resistance rate was less than 50% for cefepime,Cefoperazone / Shubatan,piperacillin / tazobactam,amikacin and imipenem.The last two are less than 30%.In addition to ampicillin and cefazolin,the resistance rates of other antibiotics were lower than 50% in general wards.The drug resistance rate of amikacin and imipenem was less than 10%.(5)There was no statistic difference in the resistance rate of Escherichia coli between RICU and general wards.The resistance rates of Cefoperazone / Shubatan,piperacillin / tazobactam,amikacin and imipenem were all lower than 50%.It is similar to Klebsiella pneumoniae except cefepime.The resistance rates of Cefoperazone / Shubatan,piperacillin / tazobactam,amikacin and imipenem were all lower than 20% in general wards.Conclusions:1?There was no significant differences in the constituent ratio of two common pathogens: Klebsiella pneumoniae and Escherichia coli of LRTI in RICU and general wards.2?The detection rate of Klebsiella pneumoniae was significantly higher than that of Escherichia coli in both of RICU and general wards.3?For the treatment of LRTI caused by Klebsiella pneumoniae,the treatment of imipenem or imipenem combined with amikacin is advisable for empirical treatment in RICU and general wards.For Escherichia coli,the choice of empirical therapy scheme is beta lactam / beta lactamase inhibitors(Cefoperazone / Shubatan,piperacillin / tazobactam and imipenem)or imipenem,or one of the both above combined with amikacin. |
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