105例小儿肺炎克雷伯菌性肺炎临床分析

Clinical analysis of pneumonia caused by Klebsiella pneumonia in 105 children

目的探讨小儿肺炎产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌感染发生率及耐药特点,为临床合理选用抗菌药物提供依据。方法对医院2009年1月-2011年12月收治的476例细菌性感染肺炎住院患儿痰标本中分离出的105株肺炎克雷伯菌及药敏结果进行回顾性分析。结果检出肺炎克雷伯菌产ESBLs菌株33株,检出率为31.4%;肺炎克雷伯菌对亚胺培南敏感率为100.0%;对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的敏感率分别为77.1%、81.9%,显著高于其他β-内酰胺类抗菌药物;病程初次使用抗菌药物患儿产ESBLs检出率仅为17.1%,而非初次使用抗菌药物产ESBLs检出率高达38.6%,两者比较差异有统计学意义(χ2=4.97,P<0.05)。结论哌拉西林/他唑巴坦、头孢哌酮/舒巴坦可作为小儿克雷伯菌肺炎的首选药物,碳青霉烯类抗菌药物作为产ESBLs肺炎克雷伯菌严重感染者尤其是合并有基础疾病患儿治疗的首选药物。

OBJECTIVE To explore the incidence of extended spectrum β-1actamases （ESBLs）-producing Klebsiella pneumonia infections in the children and analyze the characteristics of drug resistance so as to provide a reasonable reference for the clinical use of antibiotics . METHODS Totally 150 strains of K. pneumoniae isolated from the sputum specimens from 476 hospitalized children who enrolled the hospital from Jan 2009 to Dec 2011 were retrospectively analyzed, and the result of the drug susceptibility testing was observed. RESULTS There were 33 strains of ESBLs-producing K. pneumoniae with the detection rate of 31.4%. The drug susceptibility rate of the K. pneumoniae to imipenem was 100.0%, and the drug susceptibility rates to cefperazone-sulbactam and piperacillin- tazobactam were 77.1% and 81.9 %, respectively, significantly higher than that to other β-lactam antibiotics. Only 17.1 % of the children were detected with ESBLs for the first time use of antibiotics,and 38.6 % of those who did not use antibiotics for the first time, the difference was statistically significant （χ2 = 4. 97, P〈0. 05）. CONCLUSION Cefperazone-sulbactam and piperacillin-tazobactam are the preferred antibiotics for the treatment of K. pneumoniae infections, and carbopenem antibiotics are the preferred choice for the children with severe infections caused by ESBLs-producing K. pneumoniae, especially those complicated by the underlying diseases.