新生儿肺炎克雷伯菌感染及耐药分析  

Infection and antibiotic resistance of Klebsiella pneumoniae in neonates

作　　者：李伟中[1] 林佩贤[1] 辜红妮[2] 陈晓东[1] 杨汉华[1] 林伟青[1] 

机构地区：[1]汕头大学医学院第二附属医院儿科,广东省汕头市515041 [2]汕头大学医学院第二附属医院检验科,广东省汕头市515041

出　　处：《国际流行病学传染病学杂志》2014年第2期82-85,共4页International Journal of Epidemiology and Infectious Disease

基　　金：广东省科技厅社会发展计划项目（20128031800216）

摘　　要：目的了解新生儿肺炎克雷伯菌感染及耐药情况，为指导临床治疗提供依据。方法对汕头大学医学院第二附属医院新生儿病区2011—2012年的临床样本中分离培养出的106株肺炎克雷伯菌进行调查，并分析其耐药情况。结果106株肺炎克雷伯菌中，超广谱13内酰胺酶（ESBL）阳性菌株为60株（56．60％）。药敏结果显示，菌株对左氧氟沙星、头孢他啶、哌拉西林／他唑巴坦、头孢替坦、阿米卡星、头孢吡肟、亚胺培南、厄他培南的敏感率较高（81．13％-97．17％），对氨苄西林、复方磺胺甲嗯唑、氨苄西林／舒巴坦、头孢唑林和头孢曲松耐药率较高（58．49％-100．00％）。新生儿患者院内感染病例所占的比例为20．75％，高于普通儿科患者的1．27％，差异有统计学意义（X^2=28．96，P〈0．05）。引起新生儿肺炎克雷伯菌医院感染的菌株多数为耐药菌株（ESBLs阳性率77．27％）。ESBLs阳性菌株感染者的住院时间和住院费用分别为（26．02±10．16）d和（31982．55±19386．10）元，高于阴性菌株感染者（t：7．31、4．57，P〈0．01）。结论肺炎克雷伯菌是引起新生儿感染的常见细菌，其中ESBL阳性菌株对多种抗菌药物呈现耐药，引起的疾病负担较重。Objective To investigate the infection of Klebsiella pneumoniae in neonates and its antibiotic resistance, so as to provide evidence for clinical use of antibiotics. Methods One hundred and six samples of Klebsiella pneumoniae were collected from the neonate ward of the Second Affiliated Hospital, College of Medicine, Shantou University from 2011 to 2012. Their drug susceptibility was analyzed. Results Of 106 strains of Klebsiella pneumoniae, 60 （56.60%） were positive for extended spectrum β lactamase （ESBL）. Drug susceptibility test showed that strains were sensitive to levofloxacin, ceftazidime, TZP, cefotetan, amikacin, cefepime, imipenem, and ertapenem （81.13%-97.17%） and resistant to ampicillin, SMZ-TMP, ampicillin- sulbactum, cefazolin, and ceftriaxone （58.49%-100.00%）. The incidence of nosocomial infection in neaonates was higher than that in common child patients （20.75% vs 1.27%,X2=28.96, P〈0.05）. The pathogens of nosoeomial infection were mostly drug-resistant strains, among which ESBL-positive strains accounted for 77.27%. The hospitalization time and expenses of neonates infected by ESBL-positive strains were （26.02±10.16） d and （31 983.55±19 386.10） RMB, which were both higher than those of ESBL-negative ones （t=7.31, 4.57, P〈0.01）. Conclusions Klebsiella pneumoniae is a common pathogen of infection in neonatal ward. ESBL-positive strains usually present multiple drug resistance and thus their infection may lead to heavier burden of disease.

关 键 词：克雷伯菌 肺炎 婴儿 新生 抗药性 

分 类 号：R446.5[医药卫生—诊断学]