儿童下呼吸道感染肺炎克雷伯菌流行特点

Characteristics of Pneumonia klebsiella prevalent in children with a lower respiratory tract infection

目的分析儿童下呼吸道感染肺炎克雷伯菌流行特点,为其临床治疗提供科学指导。方法选取本院2012年1月-2014年12月确诊的1 130例下呼吸道感染患儿,收集患儿痰液样本,不重复送检同一患者的标本。对病原菌进行培养分离和鉴定,并进行耐药性分析。结果 1 130例下呼吸道感染患儿中,发生肺炎克雷伯菌感染数为331例,阳性率29.29%,感染类型包括支气管肺炎感染、支气管炎感染和毛细支气管炎感染,病例数分别为727、238和165例,肺炎克雷伯菌感染267、16和48例,感染率为36.73%、6.72%和29.09%。除肺部湿罗音及哮鸣音对感染发生影响不大(P>0.05)外,年龄、性别、发热、并发症、胸片肺纹理、抗菌药物、营养良、以及病程分布均是导致患者感染发生的相关因素(P均<0.05)。下呼吸道感染患儿感染的肺炎克雷伯菌对各类抗菌药物均产生了耐药性,耐药性从低到高依次为亚胺培南(4.83%)、左氧氟沙星(10.88%)、环丙沙星(22.96%)、阿米卡星(33.84%)、氨曲南(38.97%)、头孢他啶(42.90%)、头孢噻肟(47.73%)、阿莫西林(50.76%)、头孢呋辛(66.77%)。结论患儿肺炎克雷伯菌感染因素较多,感染率较高;感染的肺炎克雷伯菌对各类抗菌药物均产生了耐药性。

Objective The characteristics of Klebsiella pneumoniae prevalent in children with a lower respiratory tract infection were analyzed to provide scientific guidance for the clinical treatment of pneumonia. Methods Subjects were 1130 children with a lower respiratory tract infection who were seen from January 2012 to December 2014.Sputum samples were collected,and multiple specimens from the same pediatric patients were not tested.Pathogenic bacteria were cultured,isolated,and identified,and their drug resistance was analyzed. Results Of the 1 130 pediatric patients with lower respiratory tract infections,331 were infected with K.pneumoniae,for a rate of infection of 29.29%.Forms of infection included bronchial pneumonia（36.73%）,bronchitis（6.72%）,and bronchiolitis（29.09%）.Bronchial pneumonia was the most prevalent form of infection.An analysis of related factors revealed that crackles and wheezes had little effect on the development of an infection（P〉0.05）.However,age,gender,a fever,complications,patches on chest films,antimicrobials,malnutrition,and the course of disease were factors related to the development of an infection in patients（P〈0.05）.K.pneumoniae prevalent in children with a lower respiratory tract infection had developed resistance to a number of antimicrobials.K.pneumoniae was least resistant to imipenem（4.83%）,followed by levofloxacin（10.88%）,ciprofloxacin（22.96%）,amikacin（33.84%）,aztreonam（38.97%）,ceftazidime（42.90%）,cefotaxime（47.73%）,amoxicillin（50.76%）,and cefuroxime（66.77%）. Conclusion K.pneumoniae in children with a lower respiratory tract infection often caused bronchial pneumonia,and P.klebsiella was resistant to a number of antimicrobial drugs.The drug resistance of K.pneumoniae was related to numerous factors,resulting in the high morbidity of K.pneumoniae.