49例儿童肺炎克雷伯杆菌肺炎耐药性分析

Analysis of 49 cases of the resistance of Klebsiella pneumoniae pneumonia in children

目的探讨儿童肺炎克雷伯杆菌肺炎的临床特征及该菌产生超广谱β-内酰胺酶(ESBLS)的耐药特点,为临床合理使用抗生素提供依据。方法对2007年1月～2009年1月在我院儿科住院确诊为肺炎克雷伯杆菌肺炎49例患儿的临床特征及药敏结果进行分析。结果婴幼儿,尤其是1岁以内儿童因免疫功能低下易患肺炎克雷伯杆菌肺炎,其临床表现以发热、咳嗽、咳痰气促为主不具特征性,X线表现不典型。49例患儿中,34例ESBLS检测阴性的克雷伯杆菌对多种抗生素较为敏感,但15例ESBLS检测阳性的肺炎克雷伯杆菌对多种抗生素具有交叉耐药性,对含酶的头孢菌素和碳青霉烯类抗生素敏感率较高。结论儿童肺炎克雷伯杆菌肺炎临床表现不具有特征性,疾病进展快,诊断靠病原菌检测并结合临床表现和X线检查,治疗应根据药敏测定,合理选择有效抗生素。

Objective To study the clinical features of Klebsiella pneumoniae pneumonia in children and the resistance of Klebsiella pneumoniae which produced ESBLs.Methods The clinical features and the results of drug sensitivity test of 49 pediatrics diagnosed Klebsiella pneumoniae pneumonia were analyzed.Result The children especially those younger than one year were susceptible to Klebsiella pneumoniae pneumonia.Fever,cough,expectoration and anhelation were the main clinical manifestations which are atypical as well as the X-ray.Klebsiella pneumoniae with ESBLs（-）（34 cases） were sensitive to many antibiotics.Klebsiella pneumoniae with ESBLs（＋）（15 cases） were cross-resistance to many antibiotics but sensitive to cephalosporin with activity and carbon vingl cephalosporin.Conclusion The clinical manifestations of Klebsiella pneumoniae pneumonia in children are atypical.It＇s more common in immunocompromised children 0-1 year old and rapidly progressed.To diagnose the disease need the pathogen detection,clinical manifestations and X-ray examination.The determination of reasonable treatment choice should be based on antibiotic susceptibility.