新生儿肺炎克雷伯菌败血症临床分析  

Clinical analysis of klebsiella pneumonia sepsis in neonatal ward

作　　者：吕媛[1] 任静[1] 缪珀[1] 陶云珍[1] 孙斌[1] 冯星[1] 

机构地区：[1]苏州大学附属儿童医院新生儿科,205003

出　　处：《中国新生儿科杂志》2013年第2期76-79,共4页Chinese Journal of Neonatology

基　　金：国家自然基金资助项目(81271378)

摘　　要：目的探讨近年来我院新生儿病房肺炎克雷伯菌败血症的临床表现及药敏特点,以指导临床治疗。方法回顾性分析本院新生儿病房2008年1月至2011年11月血培养确诊为肺炎克雷伯菌败血症患儿的临床资料、细菌药敏试验结果及治疗经过。结果研究期间我院新生儿病房收治患儿12580例,血培养确诊败血症268例,其中肺炎克雷伯菌败血症51例,4年间肺炎克雷伯菌败血症患病率0.40%,在新生儿败血症病原菌中居第3位,男婴患病率高于女婴(0.52%比0.28%),早产儿患病率明显高于足月儿(1.42%比0.15%),低出生体重儿患病率明显高于非低出生体重儿(0.95%比0.21%),P均<0.05。肺炎克雷伯菌败血症早期临床表现多不典型,及时跟踪血常规、C反应蛋白等检查并结合血培养结果可提高早期诊断阳性率。目前肺炎克雷伯菌对碳青霉烯类、喹诺酮类、氨基糖甙类及头孢西丁的敏感率仍为100%,但对加酶β-内酰胺类抗生素的敏感性存在随年份分布的差异。结论肺炎克雷伯菌目前仍是我院新生儿败血症的主要病原之一,早产、低出生体重等是发病的危险因素;碳青霉烯类及含β-内酰胺酶抑制剂复合物的抗生素是治疗的首选药物。Objective To investigate clinical presentations and drug resistance characteristics of Klebsiella pneumonia sepsis in NICU to provide evidence of guidance for future clinical managements. Methods Neonates admitted to neonatal ward from 2008 to 2011 with blood culture confirmed Klebsiella pneumonia sepsis were enrolled in this study. Retrospective analysis was conducted on clinical data, drug sensitivity test results and courses of treatments. Results Total of 12580 infants were admitted during the study period. Among the 268 infants were diagnosed with sepsis confirmed with positive blood cultures, 51 patients were diagnosed with Klebsiella pneumonia sepsis, which prepresented 0. 4% of all hospital admissions, ranked third in all neonatal septic cases and was more common among male infants （0. 52% to 0.28%, P 〈0. 05）. The disease incidence was significantly higher in preterm （ 1.42% vs. 0. 15%, P 〈0.05）, and low birth weight （0.95% vs. 0.21%, P 〈0.05） infants. Because early clinical presentations of most Klebsiella pneumonia sepsis cases are atypical, close follow up of routine blood counts, C-reactive protein, and blood culture results can improve the rate of early diagnosis. While Klebsiella pneumoniae is 100% sensitive to carbopenems, quinolones, aminoglycosides and cefoxitin at this time, the sensitivity to β-lactamase resistant antibiotics varies each year. Conclusions Klebsiella pneumonia is one of the leading causes of neonatal sepsis in hospitalized newborn patients. Premature birth and low birth weight are risk factors of Klebsiella pneumoni sepsis. Carbapenems and β-1actamase inhibitor compound are the antibiotics of choice intreatment of Klebsiella pneumoni sepsis.

关 键 词：肺炎克雷伯菌 败血症 超广谱Β-内酰胺酶 婴儿 新生 

分 类 号：R446.5[医药卫生—诊断学]