Phân tích đặc điểm lâm sàng, vi sinh và sử dụng kháng sinh điều trị nhiễm khuẩn huyết do Klebsiella pneumoniae và Escherichia coli tại Viện Huyết học – Truyền máu Trung ương

Objectives: To analyze clinical features, microbiological characteristics and antimicrobial therapies in patients with bacteremia due to K. pneumoniae and E. coli at The National Institute of Hematology and Blood Transfusion (NIHBT) from 2018 to 2019. Study subjects: Medical records and inpatient management data of adult patients with positive blood cultures for K.pneumoniae and/or E.coli of NIHBT from 2018 to 2019. Methods: A retrospective cohort study using data retrived from medical records and hospital management software. Results: A total of 393 medical records of patients were included. The percentage of patients with neutropenia, history of hospitalization, chemotherapeutics and antibiotics within 90 days ranged from 70-85%. E. coli were major pathogen, with 70%. The susceptibilities of E. coli and K. pneumoniae to 3^rd/4^th-generation cephalosporins (50% and 25%, respectively) and carbapenem (75% and 89%, respectively) were substantial difference. Empirical treatment options were mainly based on 3^rd/4^th-generation cephalosporins in combination with aminoglycosides and fluoroquinolones. Predominant options after antimicrobial susceptibility testing were carbapenem-based regimens associated with aminoglycosides. 56.6% of empirical therapies and 97.4% of definitive therapies were assessed as appropriate based on antibiogram. Conclusion: The resistance of E. coli was significantly different from K. pneumoniae. Based on antibiogram, the percentage of appropriateness of empirical therapies was relatively low. Our results suggest the need of stratification to predictfor the risk of antibiotic resistance in patients with K. pneumoniae and E. coli bacteremia, which could help optimize selection of empirical antibiotic therapies.

Keywords: Klebsiella pneumoniae, Escherichia coli.

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