摘要
目的：探讨儿童社区感染肺炎克雷伯菌分布特点及对抗菌药物耐药情况，为临床诊治儿童社区感染肺炎克雷伯菌提供参考，为制定医院感染防治对策及措施提供依据。方法采用回顾性研究，对2013年1月～12月临床分离社区感染肺炎克雷伯菌的临床特征和耐药性进行分析。结果121例患儿中，0～3月龄者84例，占69.4％。标本来源主要来自下呼吸道（47.1％）、中段尿（14.0％）和咽拭子标本（12.4％）；来源科室主要为新生儿及NICU（39.7％），其次为儿童外科（18.2％）和 PICU（13.2％）。其中，产超广谱β-内酰胺酶（ESBLs）菌71株，占58.7％；社区感染肺炎克雷伯菌对头孢唑啉、头孢曲松、氨苄西林/舒巴坦、氨曲南、头孢他啶耐药性均大于40％；对亚胺培南、美罗培南和厄他培南等碳氢霉烯类耐药性较低。产ESBLs菌株对氨曲南、头孢他啶、头孢曲松、头孢唑啉、庆大霉素、氨苄西林/舒巴坦、头孢哌酮/舒巴坦的耐药率明显高于非产ESBLs菌株（p＜0.05）。结论社区感染肺炎克雷伯菌常见于3月龄及以下婴幼儿。儿童社区感染肺炎克雷伯菌耐药形式严峻，产ESBLs菌株耐药率高，临床需要加强抗生素的管理，合理使用抗生素。
Objective To explore the distribution and antimicrobial resistance of community -acquired Klebsiella pneumoniae infection in pediatrics, offer references for clinical treatment, and provide the basis for the development of noso-comial infection control strategies and measures.Methods Retrospective study was used to collect the information of commu-nity-acquired Klebsiella pneumoniae infection from Jan to Dec 2013 in pediatrics, clinical features and antimicrobial resist-ance of pathogens were analysed.Results Of the 121 pediatrics, 84 cases （69.4%） were aged zero to three months.The sample were main from secretion （47.1%）, urine （14.0%） and throat swab （12.4%） , and were main from the depart-ment of Neonatal intensive care unit （including neonatal ward） （39.7%）, pediatric surgery ward （18.2%） and pediatric intensive care unit （13.2%）.Seventy-one strains （58.7%） of ESBLs -producing were detected.The resistant rates of Klebsiella pneumonia to cefazolin, ceftriaxone, ampicillin /sulbactam, aztreonam, ceftazidime were higher than 40%, and the rate to carbapenems was lower.The resistance rates of ESBLs-producing strains to aztreonam, ceftazidime, ceftriaxone, cefazolin, gentamycin, ampicillin /sulbactam, sulbactam/cefopcrazone were significantly higher than for non-ESBLs-pro-ducing strains（p＆lt;0.05）.Conclusion Community-acquired Klebsiella pneumoniae infection is common in infants aged ≤3 months.The resistance of Klebsiella pneumoniae infection in pediatrics was still serious , ESBLs -producing strains were demonstrated higher rates of drug resistance.The clinicians should reasonably use antibiotics based on the results of drug sus-ceptibility testing, and institute effective measures to reduce antimicrobial resistance.
出处
《现代医院》
2014年第8期79-81,84,共4页
Modern Hospitals
基金
广东省人口和计划生育委员会科研项目(编号:2008062)
关键词
肺炎克雷伯菌
耐药性
儿科
社区感染
Klebsiella pneumoniae
Antimicrobial resistance
Pediatrics
Community-acquired infection
