儿童下呼吸道肺炎克雷伯菌感染药敏分析  

Drug susceptibility of Klebsiella pneumoniae causing lower respiratory tract infections in children

作　　者：鲁承熙[1] 熊伟 王玉林[3] 韦翊[4] 

机构地区：[1]贵阳医学院附属医院儿科,贵州贵阳550004 [2]贵阳市云岩黔灵人民医院儿科,贵州贵阳550001 [3]贵阳医学院,贵州贵阳550004 [4]杭州市第六人民医院儿科,浙江杭州310014

出　　处：《中华医院感染学杂志》2014年第18期4427-4428,4431,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生基金资助项目(2011KYB072)

摘　　要：目的分析儿童下呼吸道感染肺炎克雷伯菌的感染情况及药敏性,以减少感染的发生。方法在患儿下呼吸道分泌物标本中分离、培养出的肺炎克雷伯菌采用纸片扩散(K-B)法进行ESBLs菌株筛查和确证。结果 874例患儿细菌培养阳性257例,阳性率为29.4%,分离出肺炎克雷伯菌84株,检出率9.6%;肺炎克雷伯菌对头孢唑林、磺胺甲噁唑/甲氧苄啶、头孢噻肟、氨苄西林及阿莫西林/克拉维酸的耐药率较高,分别为59.5%、59.5%、56.0%、66.7%、61.9%;经检测有39株产ESBLs肺炎克雷伯菌,占46.4%;产ESBLs菌株对头孢唑林、头孢曲松、氨苄西林和头孢噻肟等抗菌药物均有极强的耐药性,对氨苄西林/舒巴坦、妥布霉素的耐药率相对较低,<50.0%,对环丙沙星耐药率最低,仅为2.6%。结论儿童下呼吸道肺炎克雷伯菌感染以1岁以下婴儿为主,产ESBLs肺炎克雷伯菌所占比例较高,对常用β-内酰胺类抗菌药物存在较高耐药率,对环丙沙星敏感。OBJECTIVE To analyze the incidence of lower respiratory tract infections caused by K lebsiella pneumon-iae and observe the drug susceptibility so as to reduce the incidence of infections .METHODS The K .pneumoniae strains were isolated and cultured from the lower respiratory tract secretions obtained from the children ,then the ESBLs-producing strains were screened and identified by using disk diffusion method （K-B method） .RESULTS Of the 874 children ,257 were cultured positive for bacteria ,with the positive rate of 29 .4% ;totally 84 strains of K .pneumoniae were isolated ,with the isolation rate of 9 .6% .The results of drug susceptibility testing indicated that the drug resistance rates of the K .pneumoniae to cefazolin ,sulfamethoxazole-trimethoprim ,cefotaxime ,am-picillin ,and amoxicillin-clavulanic acid were 59 .5% ,59 .5% ,56 .0% ,66 .7% ,and 61 .9% ,respectively .Totally 39 strains of ESBLs-producing K .pneumoniae were detected positive ,accounting for 46 .4% .The ESBLs-produ-cing strains were highly resistant to cefazolin ,ceftriaxone ,ampicillin ,and cefotaxime ,the drug resistance rates to ampicillin-sulbactam and tobramycin were less than 50 .0% ,and the drug resistance rate to ciprofloxacin was the lowest （2 .6% ） .CONCLUSION The children aged less than one year old are the major population at high risk of lower respiratory tract infections caused by the K .pneumoniae;the ESBLs-producing K .pneumoniae strains occu-py a high proportion and are highly resistant to the commonly used β-lactams and susceptible to ciprofloxacin .

关 键 词：儿童 下呼吸道感染 肺炎克雷伯菌 药敏分析 

分 类 号：R378.996[医药卫生—病原生物学]