儿童耐碳青霉烯类肺炎克雷伯菌的临床分布及耐药性分析

Analysis of the clinical distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae in children

目的调查分析儿童耐碳青霉烯类肺炎克雷伯菌(CRKP)的临床分布及其耐药性。方法收集2015年12月至2018年12月我院住院患儿的各类送检标本,对送检标本进行CRKP分离培养和细菌鉴定。并采用K-B法和药敏卡对分离出的CRKP菌株进行药敏试验。分析儿童CRKP感染的分布特点,并分析其对常用抗菌药物的耐药性。结果共计分离出156株CRKP,其中Carba NP实验检出阳性149例,阳性率95.51%。其中主要标本来自于痰液和尿液,占比分别为51.28%、16.67%。CRKP菌株标本来源的主要科室包括新生儿科(29.49%)、呼吸科(25.64%)以及ICU科(14.10%)。在临床常用的其他16种抗生素中,CRKP对头孢类、青霉素类以及喹诺酮类抗生素耐药性达到了90%以上,对氨基糖甙类、四环素类以及磺胺类抗生素耐药性较低。结论儿童的CRKP感染情况较为广泛,尤其新生儿科最为严重。且CRKP的耐药情况严重,对绝大多数的抗生素均有较高的耐药性,因此临床要根据药敏结果合理选择抗菌药物,以有效控制感染。

Objective To investigate and analyze the clinical distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae(CRKP)in children.Methods All kinds of submitted samples of children hospitalized in the hospital from December 2015 to December 2018 were collected.Isolation and culture of CRKP and bacterial identification were performed on the submitted samples.The K-B method and drug sensitivity card were used to test the sensitivity of the isolated CRKP strains.The distribution characteristics of CRKP infection in children were analyzed,and the resistance to commonly used antibacterial drugs was analyzed.Results A total of 156 strains of CRKP were isolated,including 149 strains detected by Carba NP test,with a positive rate of 95.51%.The main specimens were sputum and urine specimens,accounting for 51.28%and 16.67%,respectively.The main departments from which CRKP strain specimens came included the Neonatology Department(29.49%),the Respiratory Department(25.64%)and the ICU(14.10%).Among the other 16 antibiotics commonly used in the clinic,the resistance rates of CRKP to cephalosporins,penicillins and quinolone antibiotics were higher than 90%.The resistance to aminoglycoside,tetracyclines and sulfonamides was relatively low.Conclusion CRKP infection is widespread in children,especially in the Neonatology Department.In addition,the resistance of carbapenem-resistant Klebsiella pneumoniae is serious,and it has high resistance to most of the antibiotics.Therefore,it is necessary to choose antibiotics reasonably according to the results of drug sensitivity so as to effectively control infection.