广州地区儿童院内、外肺炎克雷伯菌感染特点及耐药性对比研究

Comparison of clinical features and antimicrobial resistance of community and hospital-acquired Klebsiella pneumoniae infection in pediatrics

目的探讨儿童院内、外肺炎克雷伯菌分布特点及对抗生素耐药性情况,为临床诊治儿童肺炎克雷伯菌感染提供参考依据。方法采用回顾性研究,对2013年1-12月我院临床分离院内、外肺炎克雷伯菌的临床特征和耐药性进行数据对比分析。结果共分离216例儿童肺炎克雷伯菌,其中社区感染标本121株,院内感染标本95株;两组住院时间和住院费用差异有统计学意义(P<0.05),但是在年龄分布和转归差异无统计学意义;两组标本来源、科室分布差异有统计学意义(P<0.05);院感组产超广谱β-内酰胺酶(ESBLs)阳性株检出率(84.9%)明显高于社区组(58.7%)(P<0.05);院内与社区肺炎克雷伯菌感染对常见抗生素耐药性差异无统计学意义(P>0.05)。结论儿童院内、外肺炎克雷伯菌感染特点存在一定差异,肺炎克雷伯菌耐药形式仍较为严峻,临床需要加强抗生素的管理,合理使用抗生素。

Objective To explore the distribution and antimicrobial resistance of community and hospital-acquired Klebsiella pneumoniae infection in pediatrics, and offer reference for clinical diagnosis and treatment. Methods Retrospective study was used to investigate community and hospital-acquired Klebsiella pneumoniae infection from Jan to Dec 2013 in pediatrics.Clinical features and antimicrobial resistance of pathogens were analyzed. Results Among 216 isolated stains, 121 strains were from community-acquired infection, and 95 strains were from hospital-acquired infection. The difference of cost and days in hospital were significantly different （P〈0.05）. Two groups of samples and distribution of departments were significantly different （P〈0.05）. Extendeol spectrum beta lactamases （ESBLs） positive strains detected rate in the hospital-acquired strains （84.9%） was significantly higher than that of community-acquired strains （58.7%）（P〈0.05）. There are no significant differences between hospital group and community group on common antibiotic resistance （P〉O.05）. Conclusion There are differences between community-and hospital-acquired Klebsiella pneumoniae infections. Drug resistance of Klebsiella pneumoniae infection in pediatrics was still serious. The clinicians should reasonable use antibiotics based on the results of drug susceptibility testing, and hospitals should implement effective measures toreduce antimicrobial resistance.