儿童下呼吸道肺炎克雷白杆菌感染临床及药敏分析

Clinical and drug sensitivity analyses of klebsiella pneumoniae infection in children

目的探讨儿童下呼吸道肺炎克雷白杆菌感染的临床情况以及细菌的耐药性,给予临床用药指导性建议。方法选取湖北省十堰市妇幼保健院2011年4月至2013年6月下呼吸道感染患儿720例,其中肺炎克雷白杆菌感染患者178例,并选取同期非下呼吸道感染患儿640例,总结患儿临床特点,实施药敏试验,分析结果。结果下呼吸道感染患儿发生肺炎克雷白杆菌感染的例数远高于其它感染患儿,对比差异有统计学意义。性别、湿啰音及哮鸣音对感染发生率影响不大;患者临床表现有发热、住院时间长、存在并发症、胸片肺纹理增粗、应用抗菌药均导致较高的KB感染率,对比差异有统计学意义。肺炎克雷白杆菌对于喹诺酮类、氨基糖甙类、第三代头孢菌素等抗菌物耐药率较高,其中耐药率较低的是亚胺培南、头孢哌酮/舒巴坦。结论婴幼儿是肺炎克雷白杆菌感染的高发群体,合理使用以第三代头孢菌素为主的抗菌药物对抗肺炎克雷白杆菌感染意义重大。

Objective To investigate the clinical manifestations and bacterial resistance of Klebsiella pneumoniae （ K. pneumoniae） in- fection in children in order to give reference for clinical work. Methods A total of 720 children cases of lower respiratory tract infections （ 178 ca- ses of K. pneumoniae infection） who were treated in Maternal and Child Health Hospital of Shiyan from April 2011 to June 2013 were studied. Six hundred forty children without lower respiratory tract infections treated in the same period were used for comparison. The clinical characteristics and susceptibility test results of children with lower respiratory tract infections were analyzed. Results The number of K. pneumoniae infection in children with lower respiratory tract infections was much higher than children with other infections, the difference was statistically significant. The patients with fever, long hospital stay, complications, increased lung markings and use of antimicrebial drugs showed higher incidence of K. pneu- moniae infection. The drug - resistant rate of K. pneumoniae to quinolones, aminoglycosides, and third - generation cephalosporin was high, while it was low to imipenem, cefoperazone / sulbactam. Conclusion K. pneumoniae infection is often found in children. The rational use of third - generation cephalosporin - based antibiotics is significant for the decrease of the infection.