儿童肺炎克雷伯菌脓毒症临床特点及细菌耐药性分析

Analysis of clinical characteristics and bacterial drug resistance in children with Klebsiella pneumoniae sepsis

目的探讨儿童肺炎克雷伯菌脓毒症的临床特点及细菌耐药情况,为临床诊断和合理用药提供依据。方法回顾性分析重庆医科大学附属儿童医院2009年1月至2011年12月3年中诊断为肺炎克雷伯脓毒症患儿的临床资料,分析临床特点及细菌耐药情况。结果 34例患儿中,新生儿24例,非新生儿10例。新生儿临床常见反应差、神经系统受累(87.5%)表现,早产、低出生体重(54.2%),侵入性操作史(37.5%),双胎及围生期窒息(25.0%)者均易感。非新生儿中发热多见(70.0%),有侵入性操作史者(70.0%)易感。常见伴随疾病包括肺炎(85.3%)、先天性心脏病(41.2%)等。血培养阳性标本采样前7天内,二、三代头孢及哌拉西林/三唑巴坦使用史多见,分别为32.4%、26.5%、29.4%,非新生儿二、三代头孢菌素类抗生素使用多于新生儿(P<0.05)。所有菌株均为多重耐药株,对含酶抑制剂复合制剂耐药率均>65%,其中,氨苄西林/舒巴坦最高(94.1%);对头孢菌素类、氨曲南耐药率均>85%,其中,头孢他啶最低(85.3%);对碳青霉烯类、喹诺酮类敏感性高。超广谱β-内酰胺酶(ESBLs)阳性率为76%,无碳青霉烯酶(KPC)阳性菌株。结论新生儿及非新生儿肺炎克雷伯脓毒症,临床特点各异,细菌耐药严重,应重视对抗生素使用史的确证,加强抗菌药物的合理使用。

Objective To analyse the clinical characteristics and bacterial drug resistance in children with Klebsiella pneumoniae sepsis so as to improve clinical diagnosis and guide using of antimicrobial agents. Methods A retrospective study was carried out in 34 childen patients who suffered the Klebsiella pneumoniae sepsis from January 2009 to December 2011 in the Children＇s Hospital of Chongqing Medical University. The clinical features and results of antibiotic resistance were analysed. Results In 34 cases, 24 were neonate, the other were non- neonatal patients. Low response and nervous system involvement （87.5%）were often observed in the neonatal sepsis. The common susceptible factors included prematurity and low birth weight（both 54.2%）, previous using of invasive devices（37.5%）, and twins and perinatal asphyxia（both 25.0%）. Fever（70.0%） often happened in the non-neonatal patients, and previous using of invasive devices（70.0%） was the susceptible factor. The common concomitant diseases included pneumonia（85.3%）, congenital heart disease（41.2%） etc. Within 7 days before the collection of blood culture positive specimen, the common prior antimicrobial exposure were the second and the third generation of cephalosporins and piperacillin-tazobactam, and the rates were 32.4%, 26.5% and 29.4% respectively. The use of the second and the third generation of cephalosporins in the non-neonatal patients were more than the neonate （P〈0.05）. All stains were multidrug-resistant bacteria. The resistance to ^-lactamase and 13-1actamase inhibitors combinations was more than 65%, and the resistance to ampicillin-sulbactam was the highest（94.1%）. The resistance to cephalosporins and aztreonam was more than 85%, and the lowest was ceftazidime（85.3%）. Most of the stains were susceptible to carbapenems and quinolones. The rate of stains with positive extended spectrum beta- lactamases（ESBLs） was 76%, and the Klebsiella pneumoniae carbapenemases（KPC） was negative in all strains. Conclusion The clinical features of Klebsiella pneumoniae sepsis were different between the neonatal and non- neonatal, and the bacteria drug resistance was serious. It is important to pay attention to the previous antibiotic therapy and rational use of antimicrobial agents.