59例早产儿肺炎克雷伯菌败血症的临床特点及药敏分析

Clinical Characteristics and Drug Sensitivity Analysis of 59 Cases of Klebsiella Pneumoniae Sepsis in Premature Infants

目的总结早产儿肺炎克雷伯菌败血症的临床及药敏特点。方法回顾性分析2015年1月—2019年12月入住南京医科大学附属苏州医院新生儿科,血培养为肺炎克雷伯菌的59例早产儿败血症病例资料。根据药敏实验分为产ESBLs肺炎克雷伯菌组(产ESBLs组,n=46)与非产ESBLs组(n=13),并比较两组患儿在临床特点与药敏分析方面的差异。结果①临床特点:产ESBLs组感染前抗生素联合使用率(58.69%)明显高于非产ESBLs组(23.08%),感染时血糖>7.0 mmol/L(34.78%)明显低于非产ESBLs组(69.23%),差异有统计学意义(χ^(2)=5.14、4.92,P<0.05);②药敏分析:ESBLs组对氨苄青霉素/舒巴坦、阿莫西林/棒酸、头孢他啶、头孢噻肟、头孢唑啉、头孢呋肟、氨曲南敏感率显著低于非ESBLs组,差异有统计学意义(χ^(2)=18.85、9.05、4.88、14.69、14.69、14.69、14.36,P<0.05);两组对美罗培南、丁胺卡那霉素、庆大霉素、左旋氧氟沙星药物敏感率达100.00%。结论产ESBLs组早产儿败血症对头孢类药物的耐药率明显高于非产ESBLs组,感染前的抗生素联合使用是其危险因素。

Objective To summarize the clinical and drug susceptibility characteristics of Klebsiella pneumoniae sepsis in premature infants,and to provide a basis for clinical prevention and treatment.Methods Retrospectively analyzed the data of 59 cases of sepsis in premature infants who were admitted to the cepartment of neonatology,Suzhou Hospital Affiliated to Nanjing Medical University from January 2015 to December 2019.The blood culture was Klebsiella pneumoniae.According to the drug sensitivity test,they were divided into ESBLs-producing Klebsiella pneumoniae group(ESBLs-producing group,n=46)and non-ESBLs-producing group(n=13),and the differences in clinical characteristics and drug sensitivity analysis between the two groups were compared.Results 1.Clinical features:The pre-infection rate of antibiotics in the ESBLs-producing group(58.69%)was significantly higher than that of the non-ESBLs-producing group(23.08%),and at the time of infection blood glucose greater than 7.0 mmol/L(34.78%)was significantly lower than that of the non-ESBLs-producing group(69.23%),the difference was statistically significant(χ^(2)=5.14,4.92,P<0.05);2.Drug sensitivity analysis:ESBLs group was for ampicillin/sulbactam,amoxicillin/clavulanic acid,ceftazidime sensitivity rates of cefotaxime,cefazolin,cefuroxime,and aztreonam were significantly lower than those in the non-ESBLs group,and the differences were statistically significant(χ^(2)=18.85,9.05,4.88,14.69,14.69,14.69,14.36,P<0.05);the sensitivity rate of the two groups to meropenem,amikacin,gentamicin,and levofloxacin reached 100.00%.Conclusion The resistance rate of sepsis in preterm infants with ESBLs producing group to cephalosporins is significantly higher than that in non-ESBLs group,and the combination of antibiotics before infection is the risk factor.