儿童肺炎克雷伯菌血流感染53例临床特征及病原菌耐药性分析

Clinical features and antibiotic resistance profile of Klebsiella pneumoniae bloodstream infection in children:report of 53 cases

目的分析53例儿童肺炎克雷伯菌血流感染患者的临床特征及病原菌的药敏试验结果,为临床合理用药及预防医院感染提供参考依据。方法回顾性收集2016年1月-2020年3月临床症状符合血流感染标准,且血培养为肺炎克雷伯菌的患儿临床资料及病原菌药敏结果。结果53例发生肺炎克雷伯菌血流感染的患儿主要来自重症监护室,16例(30.2%)患有先天性心脏病,6例(11.3%)患有血液肿瘤疾病;实验室检查中,39例(73.6%)外周血白细胞升高,47例(88.7%)C反应蛋白升高,37例(69.8%)降钙素原升高。药敏试验结果表明所有分离菌株对氨苄西林耐药,对氨基糖苷类抗生素耐药率低,有25株(47.2%)为耐碳青霉烯类肺炎克雷伯菌,表现为对头孢菌素类、碳青霉烯类抗生素耐药。结论肺炎克雷伯菌血流感染患儿常伴有严重的基础疾病,病程发展迅速,病情重。耐碳青霉烯类肺炎克雷伯菌的大量出现,临床应根据患儿临床特征及药敏结果谨慎用药,合理治疗。

Objective To analyze the clinical features and antimicrobial susceptibility of Klebsiella pneumoniae bloodstream infections in 53 children for better management of nosocomial infections and rational antimicrobial therapy.Methods The cases were identified retrospectively from the database limited to the period from January 2016 through March 2020 based on the clinical symptoms consistent with bloodstream infection,and positive blood culture of K.pneumoniae.Results The 53 cases of bloodstream infection caused by K.pneumoniae were mostly from ICU.About 30.2%(16/53)of the children had congenital heart disease and 11.3%had hematological malignancy.Peripheral blood leukocyte increased in 39 children(73.6%),C-reactive protein increased in 47 cases(88.7%),and procalcitonin increased in 37(69.8%)children.Antimicrobial susceptibility test showed that all the strains were resistant to ampicillin.The strains showed low resistance to aminoglycoside antibiotics.About 47.2%(25/53)of the K.pneumoniae strains were resistant to carbapenems,which were also resistant to all cephalosporins antibiotics.Conclusions Most cases of K.pneumoniae bloodstream infection in children have serious underlying diseases.The infection usually progresses rapidly,resulting in serious consequences.The emergence of carbapenem-resistant K.pneumoniae strains makes it necessary to use antimicrobial agents carefully and rationally according to clinical indication and results of antimicrobial resistance surveillance.