山东省儿童耐碳青霉烯类肺炎克雷伯杆菌感染的临床分布和耐药性分析

Distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae infection in children in Shandong Province

目的分析山东省儿童耐碳青霉烯类肺炎克雷伯杆菌的临床分布和耐药性特点。方法收集从山东省儿童细菌&真菌耐药监测研究协作网50家成员单位2018年1月至2019年12月收住院的381例患儿中分离出的非重复耐碳青霉烯类肺炎克雷伯杆菌共381株,对患儿的性别、年龄、季节分布及菌株的样本类型、科室分布、药敏结果进行分析。结果 381例患儿中,男251例,女130例,男∶女=1.93∶1;年龄最小3 h,最大18岁。获取耐碳青霉烯类肺炎克雷伯杆菌381株。儿童耐碳青霉烯类肺炎克雷伯杆菌的季节分布显示春夏季居多。标本来源中,检出标本前3位依次为:痰液标本279株(73.23%),尿液标本25株(6.56%),血液标本24株(6.30%)。检出率高的科室前3位依次为:新生儿科163株(42.78%),儿童重症监护室86株(22.57%),外科24株(6.30%)。药敏结果显示:381株耐碳青霉烯类肺炎克雷伯杆菌除了对替加环素、阿米卡星、氯霉素、四环素、左氧氟沙星耐药率较低外,对其他抗生素的耐药率均较高。结论儿童耐碳青霉烯类肺炎克雷伯杆菌分布较为广泛,多重耐药严重,主要分离自痰液,新生儿科和儿童重症监护室分离率最高。

Objective To analyze the distribution and drug resistance characteristics of carbapenem-resistant Klebsiella pneumoniae(CRKP)infection in children in Shandong Province.Methods A total of 381 strains of non-repetitive CRKP isolated from 381 hospitalized children from January 2018 to December 2019 were collected.All the children were from 50 member units of Shandong Children’s Bacterial and Fungal Resistance Monitoring and Research Collaboration Network.The gender,age,seasonal distribution,sample type,department distribution,and drug sensitivity were analyzed.Results Among the 381 children,251 children are boys and 130 children are girls,while the ratio of males to females was 1.93∶1.The youngest was 3 hours,and the oldest was 18 years old;and 381 strains of CRKP were obtained.The seasonal distribution of CRKP in children showed that the disease developed more frequently in spring and summer.Among the samples,the first three samples with the highest detection rate were sputum samples(279 strains,73.23%),urine samples(25 strains,6.56%),blood samples(24 strains,6.30%).The first three departments with the highest detection rate were neonatology department(163 strains,42.78%),pediatric intensive care units(86 strains,22.57%),and surgery department(24 strains,6.30%),sequentially.The results of drug sensitivity showed that drug resistance rates of 381 strains of CRKP to tigecycline,amikacin,chloramphenicol,tetracycline and levofloxacin were low,and the drug resistance rates to other antibiotics were higher.Conclusions The distribution of CRKP in children is wide,with severe multi-drug resistance.It is mainly isolated from sputum.The highest isolation rate of CRKP is found in neonatology department and pediatric intensive care units.