儿科重症监护病房先天性心脏病术后肺炎克雷伯杆菌感染临床特点及药敏分析

Clinical characteristics and drug sensitivity analysis of Klebsiella pneumoniae infection in children after surgery of congenital heart disease in the pediatric intensive care unit

目的探讨儿科重症监护病房先天性心脏病术后肺炎克雷伯杆菌(Klebsiella pneumoniae,KP)-呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的临床特点及细菌耐药性分析。方法总结广东省人民医院儿科重症监护病房2014年1月至2015年12月先天性心脏病术后确诊KP-VAP患儿31例的临床资料及药物敏感试验结果。结果 2014年1月至2015年12月医院获得性肺炎患儿432例,先天性心脏病术后KP-VAP患儿31例(7.1%)。敏感抗生素分别为亚胺培南(泰能)(100.0%),头孢替坦(100.0%),厄它培南(100.0%),阿米卡星(100.0%),哌拉西林/他唑巴坦(87.2%),左氧氟沙星(87.2%),环丙沙星(87.2%);前5位耐药抗生素分别为氨苄西林(100.0%),氨苄西林/舒巴坦(84.0%),头孢曲松(80.7%),头孢唑啉(70.9%),呋喃妥因(58.1%),复方新诺明(51.6%)。结论先天性心脏病术后KP-VAP感染,在4个月龄以下婴儿感染率相对较高;经验性治疗可选用亚胺培南、厄它培南、哌拉西林/他唑巴坦、阿米卡星。

Objectives To investigate the clinical characteristics and drug sensitivity of Klebsiella pneumoniae(KP)infection in children with ventilator-associated pneumonia(VAP)after surgery of congenital heart disease in the pediat?ric intensive care unit(PICU).Methods A total of31patients with VAP caused by KP in PICU of Guangdong Gener?al Hospital from Janurary2014to December2015were investigated retrospectively.The drug resistance profile of KP was analyzed.Results There were432critically ill children received hospital acquired pneumonia in PICU from Janurary2014to December2015.Of these patients,there were31children received surgery of congenital heart disease infected with KP-VAP,the incidence rate was7.1%(31/432).Antibiotic susceptibility test showed that imipenem was the most susceptible antibiotic(100%),followed by cefotetan(100.0%),ertapenem(100.0%),amikacin(100.0%),piperacillin/tazobactam(87.2%),levofloxacin(87.2%),ciprofloxacin(87.2%).Drug resistance rate ofKP was ampicillin(100.0%),ampicillin/sulbactam(84.0%),ceftriaxone(80.7%),cefazolin(70.9%),nitrofuranto?in(58.1%)and cotrimoxazole(51.6%).Conclusions Patients less than4months old suffering from surgery of con?genital heart disease are prone to KP infection.Imipenem,ertapenem and piperacillin/tazobactam,amikacin are the best options for KP-VAP treatment.