婴幼儿社区获得性肺炎克雷伯菌肺炎的临床特点及耐药分析

Clinical features and antimicrobial resistance of community-acquired pneumonia caused by Klebsiella pneumoniae in infants

目的探讨婴幼儿社区获得性肺炎克雷伯菌肺炎的临床特点及耐药特征。方法收集2007～2011年65例婴幼儿社区获得性肺炎克雷伯菌肺炎住院病例,对其临床资料进行回顾性分析。结果 65例患儿中,≤3个月小婴儿37例(57%),4个月～17例(26%),7个月～7例(11%),13～24个月4例(6%)。患儿临床表现及X线胸片特点与其他细菌性肺炎无明显差异。产超广谱β内酰胺酶(ESBLs)肺炎克雷伯菌检出40株,检出率为62%。肺炎克雷伯菌对亚胺培南、美罗培南、阿米卡星敏感率为100%,但对青霉素、头孢菌素普遍耐药;产ESBLs菌株对青霉素类、头孢菌素类、阿莫西林/棒酸、氨苄西林/舒巴坦、复方新诺明、庆大霉素、环丙沙星及氨曲南的耐药率显著高于非产ESBLs菌株,呈多重耐药性。结论社区获得性肺炎克雷伯菌肺炎常见于3个月内的小婴儿。产ESBLs菌株在肺炎克雷伯菌社区获得性肺炎感染中非常流行,其耐药率高,且呈多重耐药性。

Objective To study the clinical features and antimicrobial resistance of community-acquired pneumonia caused by Klebsiella pneumoniae in infants.Methods The clinical data of 65 infants with community-acquired pneumonia caused by Klebsiella pneumoniae between 2007 and 2011 were retrospectively studied.Results Of the 65 infants,37 cases（57%） were aged ≤3 months,17 cases（26%） over 4 months,7 cases（11%） over 7 months and 4 cases（6%） between 13 and 24 months.There were no significant differences in clinical manifestations and chest X-ray features between the infants with community-acquired pneumonia caused by Klebsiella pneumoniae and those with other bacterial pneumonia.Forty strains（62%） of ESBLs-producing Klebsiella pneumoniae were detected.Klebsiella pneumoniae was 100% sensitive to imipenem,meropenem and amikacin but resistant to penicillins and cephalosporins.The resistance rates of ESBLs-producing strains to penicillins,cephalosporins,amoxicillin/clavulanic acid,ampicillin/sulbactam,compound sulfamethoxazole,gentamycin,ciprofloxacin and aztreonam were significantly higher than for non-ESBLs-producing strains.ESBLs-producing strains also showed multiple-drug resistance.Conclusions Community-acquired pneumonia caused by Klebsiella pneumoniae is common in infants aged ≤3 months.ESBLs-producing strains are prevalent in community-acquired pneumonia caused by Klebsiella pneumoniae and demonstrate both high rates of drug resistance and multiple-drug resistance.