Study on the clinical characteristics of infection in diabetic nephropathy patients undergoing hemodialysis and the drug resistance of Klebsiella pneumoniae
Objective The clinical characteristics of diabetic nephropathy patients with infection undergoing hemodialysis and the drug resistance of Klebsiella pneumoniae were studied,in order to provide scientific basis for the rational use of antibiotics in clinic.Methods A total of 268 diabetic nephropathy patients with infection who received hemodialysis treatment in our hospital were selected as the research objects in this study.The clinical specimens from different infection sites of the patients were collected for pathogen identification and drug susceptibility testing,and their resistance to commonly used antibiotics was analyzed.The drug resistance of extended-spectrum beta-lactamase(ESBLs)-producing K.pneumoniae and non-ESBLs-producing K.pneumoniae was compared.Results Among the 268 patients with combined infections,there were 142 cases(52.99％)of pulmonary infection,59 cases(22.01％)of digestive tract infection,46 cases(17.16％)of urinary tract infection,13 cases(4.85％)of skin and soft tissue infection,and 8 cases(2.99％)of catheter site infection.A total of 268 pathogenic bacteria were detected,including 165 strains(61.57％)of Gram-negative bacteria,90 strains(33.58％)of Gram-positive bacteria,and 13 strains(4.85％)of fungi.Among Gram-negative bacteria,the main ones were K.pneumoniae(25.37％,68/268)and Escherichia coli(13.43％,36/268).Among Gram-positive bacteria,the main ones were Staphylococcus aureus(13.06％,35/268)and Streptococcus pneumoniae(8.21％,22/268).The main fungus was Candida albicans(3.73％,10/268).Among the 68 strains of K.pneumoniae,the drug resistance rates to ampicillin,cefazolin,ceftriaxone,and gentamicin were higher than 50％,which were 80.88％,61.76％,50％,and 50％respectively.The drug resistance rates to cefepime,amikacin,imipenem,meropenem,and piperacillin/tazobactam were lower than 30％,which were 29.41％,8.82％,10.29％,14.71％,and 17.65％respectively.Among the 68 strains of K.pneumoniae,the detection rate of ESBLs-producing strains was 35.29％.ESBLs-producing K.pneumoniae was highly resistant to multiple antibiotics,especially ampicillin and cefazolin.The resistance rate to drugs such as ceftriaxone exceeded 50％,but the resistance rate to a few drugs such as amikacin was less than 30％.Non-ESBLs-producing strains had a high resistance rate to ampicillin,but had a low resistance rate to many other drugs including ceftriaxone and amikacin.There were statistically significant differences in the comparison of drug resistance rates of the two groups of strains to ampicillin,cefazolin,ceftriaxone,ceftazidime,cefepime,gentamicin,tobramycin,levofloxacin,ciprofloxacin,meropenem,aztreonam,ampicillin/sulbactam,and piperacillin/tazobactam(P＜0.05),while there was no statistically significant difference in the comparison of drug resistance rates to amikacin and imipenem(P＞0.05).Conclusion In diabetic nephropathy patients undergoing hemodialysis and with combined infections,pulmonary infections were the main type.K.pneumoniae was one of the main pathogenic bacteria,and the drug resistance problem of ESBLs-producing strains was relatively serious.In clinical treatment,attention should be paid to the detection of ESBLs-producing strains,and antibacterial drugs should be rationally selected to improve the treatment effect and reduce the generation and spread of drug-resistant strains.
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