【摘要】目的:探讨肺脓肿高毒力肺炎克雷伯菌感染危险因素及临床特征，旨在为早期识别高毒力感染高危人群提供更多参考。方法：回顾性纳入2019年1月-2022年1月于我院诊治肺炎克雷伯菌感染继发肺脓肿患者共35例，根据感染肺炎克雷伯菌类型划分为高毒力组（23例）和经典组（12例），比较两组临床特征资料、影像学资料、耐药情况及临床特征资料；采用Logistic回归模型多因素法评估肺脓肿高毒力肺炎克雷伯菌感染独立危险因素。结果：高毒力组合并糖尿病比例、合并肺外脓肿比例、合并多发感染比例、首发症状为呼吸道感染比例及影像学提示多发脓肿比例均显著高于经典组（P<0.05）；高毒力组留置导管比例和感染前接受侵袭性操作比例均显著低于经典组（P<0.05）。Logistic回归模型多因素分析结果显示，合并糖尿病是肺脓肿高毒力肺炎克雷伯菌感染独立危险因素（P<0.05）。高毒力组头孢呋辛、头孢曲松、头孢他啶、头孢吡肟、阿莫西林/克拉维酸、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦及左氧氟沙星耐药率均显著低于经典组（P<0.05）；高毒力组毒力基因型aero和rmpA+aero比例均显著高于经典组（P<0.05）。结论：肺脓肿高毒力肺炎克雷伯菌感染与合并糖尿病和多部位感染关系密切；同时该类感染主要毒力基因型为aero。

Abstract：Objective To investigate the risk factors and clinical characteristics of lung abscess patients with high virulence Klebsiella pneumoniae infection to provide more reference for early identification of high virulence infection high-risk groups. Methods 35 lung abscess patients with Klebsiella pneumoniae infection were retrospectively chosen in the period from January 2019 to January 2022 and grouped according to the types of Klebsiella pneumoniae infection into high virulence group (23 cases) and classical group (12 cases). The clinical characteristics, imaging data, drug resistance and clinical characteristics of 2 groups were compared. The independent risk factors of highly virulent Klebsiella pneumoniae infection in lung abscess were evaluated by Logistic regression model multivariate method. Results The proportion of high virulence combination with diabetes mellitus, extrapulmonary abscess, multiple infections, respiratory tract infection as the first symptom and multiple abscess as indicated by imaging were significantly higher than classical group（P<0.05）. The proportion of indignant catheters and invasive procedures before infection in the high virulence group were significantly lower than classical group（P<0.05）. Multivariate analysis of Logistic regression model showed that combined diabetes were independent risk factors of highly virulent Klebsiella pneumoniae infection in lung abscess（P<0.05）. The drug resistance rates of cefuroxime, ceftriaxone, ceftazidime, cefepime, amoxicillin/clavulanate, piperacillin/tazobactam, cefoperazone/sulbactam and levofloxacin in high virulence group were significantly lower than classic group（P<0.05）. The proportions of virulence genotype aero and rmpA+aero in high virulence group were significantly higher than classic group（P<0.05）. Conclusion High virulence Klebsiella pneumoniae infection in lung abscess was closely related to diabetes mellitus. Meanwhile, the main virulence genotype of this infection was aero.