肺炎克雷伯菌肺炎住院患儿的临床特征及耐药分析

Clinical characteristics of hospitalized children with pneumonia and the antibiotic resistance of Klebisella pneumoniae strains

目的了解肺炎克雷伯菌肺炎住院患儿的临床特征,比较不同时期肺炎克雷伯菌的耐药特点,为合理应用抗菌药物提供依据。方法用回顾性研究方法,收集2006—2015年萍乡市人民医院的肺炎住院患儿信息。以2011年首次分离到亚胺培南耐药株CRKP为时间节点,分为2006—2010年和2011—2015年两组,分析患儿临床特征并比较不同时期肺炎克雷伯菌分离株的耐药特点。结果肺炎患儿共分离到肺炎克雷伯菌117株。2006—2010年的50株肺炎克雷伯菌,未发现碳青霉烯类耐药,对氨苄西林、头孢曲松、头孢噻肟、复方磺胺的耐药率分别为36.0%、32.0%和26.0%;2011—2015年分离到67株肺炎克雷伯菌中,对氨苄西林耐药率100%,对头孢曲松、头孢噻肟、复方磺胺的耐药率分别为82.1%、70.2%和56.7%,均高于2006—2010年的耐药率;2011—2015年CRKP检出率达8.9%(6/67)。结论萍乡地区肺炎克雷伯菌已产生碳青霉烯类耐药,对青霉素类和头孢菌素类抗菌药物的耐药率增高。

Objective To study the clinical characteristics of hospitalized children with pneumonia caused by Klebisella pneumoniae(CRKP),and to compare the drug resistance of CRKP strains in different periods for rational use of antibiotics.Methods By using retrospective study method,the clinical materials from the hospitalized children with pneumonia infected by CRKP were collected in Pingxiang People’s Hospital,and according to the first isolation of carbapenem-resistant CRKP in 2011,the patients were divided into two groups(2005-2010 and 2011-2015),and the clinical characteristics and drug resistance of CRKP strains were compared for the two groups.Results Totally 117 CRKP strains were isolated from the patients.No carbapenem resistance was found in 50 CRKP isolates in 2006-2010.The resistance rates of ampicillin,ceftriaxone,cefotaxime and sulfamethoxazole were 88.0%,36.0%,32.0%and 26.0%,respectively.Totally 67 CRKP strains isolated in 2011-2015,the resistant rates of ampicillin,ceftriaxone,cefotaxime and sulfamethoxazole were 100.0%,82.1%,70.2%and 56.7%,respectively,they were significantly higher than those from 2006 to 2010.The positive rate of CRKP was 8.9%(6/67)in 2011-2015.Conclusion There exist carbapenem resistance for CRKP,the resistance rates of CRKP to penicillins and cephalosporins show higher tendency.