多药耐药肺炎克雷伯菌致小儿肠炎调查  

Multidrug-resistant Klebsiella pneumoniae causing enteritis in children

作　　者：王国庆 穆廷杰 

机构地区：[1]甘肃省临夏州人民医院儿科,甘肃临夏731100 [2]甘肃省临夏州人民医院检验科,甘肃临夏731100

出　　处：《中华医院感染学杂志》2013年第22期5564-5566,共3页Chinese Journal of Nosocomiology

基　　金：临夏回族自治区州科技计划基金项目(2009Y214)

摘　　要：目的探讨多药耐药肺炎克雷伯菌小儿肠炎的临床特征、药敏试验及治疗问题,以提高临床医师对多药耐药肺炎克雷伯菌小儿肠炎的早期识别及诊治能力。方法对经粪便细菌培养证实的51例产AmpC和ESBLs多药耐药肺炎克雷伯菌小儿肠炎的临床资料进行回顾性分析。结果 51例多药耐药肺炎克雷伯菌肠炎均与不合理使用抗菌药物有关,<2岁婴幼儿36例占70.6%,迁延性及慢性腹泻34例占66.7%;药敏试验结果显示,产AmpC和ESBLs肺炎克雷伯菌对亚胺培南/西司他丁100.0%敏感,对阿米卡星霉素较敏感,敏感率为37.3%。结论多药耐药肺炎克雷伯菌已成为小儿肠炎的重要致病菌之一,易引起<2岁小儿迁延性及慢性腹泻,治疗应强调肠道微生态平衡,口服B族维生素及对症治疗,但对少数脓血便或伴有发热等全身症状者应及时选用亚胺培南治疗。OBJECTIVE To explore the clinical characteristics of children with enteritis caused by muhidrug- resistant Klebsiella pneumoniae and analyze the drug susceptibility and treatment problems so as to improve the clinician＇ s ability in early identification and diagnosis of enteritis in the children. METHODS The clinical data of 51 chiidren with enteritis caused by AmpC-producing and ESBLs-producing muhidrug-resistant K. pneumoniae, which were validated through the feces culture, were retrospectively analyzed. RESULTS The muhidrug-resistant K. pneumoniae enteritis in the 51 children was related to the unreasonable use of antibiotics. There were 36 （70.6%） cases under the age of 2 years old% there were 34 （66.7%） cases of persistent or chronic diarrhea. The result of the drug susceptibility testing showed that the drug susceptibility rates of the AmpC-producing and ESBLs-producing K. pneumoniae to imipenem-cilastatin were 100. 0%, amikacin 37. 3%. CONCLUSION The muhidrug-resistant K. pneumoniae has become one of the major species of pathogens causing enteritis in the children of this area, which tends to cause persistent or chronic diarrhea in the children under the age of two years old. It is necessary to stress the intestinal microflora balance, and oral administration of vitamin B, as well as the symptomatic treatment; imipenem should be used in a timely manner for the treatment of the children complicated with such systemic symptoms as stool with blood and pus or fever.

关 键 词：多药耐药 肺炎克雷伯菌 肠炎 药敏试验 

分 类 号：R378.996[医药卫生—病原生物学]