小儿肺炎克雷伯菌下呼吸道感染临床特点及耐药率  

Clinical features and antimicrobial resistance of Klebsiella pneumoniae lower respiratory tract infection in children

作　　者：吴鹏[1] 周凯[1] 徐飞[1] 王晓卫[1] 姚开虎[2] 

机构地区：[1]南京医科大学附属儿童医院,江苏南京210008 [2]北京儿童医院北京市儿科研究所微生物研究室国家呼吸系统疾病临床医学研究中心,北京100045

出　　处：《中国感染控制杂志》2017年第5期413-416,422,共5页Chinese Journal of Infection Control

基　　金：国家自然科学基金(81371853);南京市科委资助项目(201605048)

摘　　要：目的了解小儿下呼吸道肺炎克雷伯菌感染的临床特征及其耐药性。方法回顾性分析2015年1—12月经痰培养确诊为下呼吸道肺炎克雷伯菌感染的107例患儿临床资料。结果 62.62%的患儿发病年龄为6个月内,64.49%的患儿为秋冬季节发病。临床均有咳嗽,39例伴有发热,主要并发症为Ⅰ型呼吸衰竭、Ⅱ型呼吸衰竭、心功能不全、电解质紊乱,其中两个系统并发症者39例(36.45%),三个系统并发症者5例(4.67%),47例(43.93%)符合重症肺炎诊断标准。43例(40.19%)有原发基础性疾病,主要是先天性心脏病、早产和低体重儿、营养不良。亚胺培南耐药菌感染患儿较非耐药菌感染患儿更易发生肺外并发症。肺炎克雷伯菌对阿米卡星(9.35%)耐药率最低。临床痊愈和显效90例,有效11例,4例未愈自动出院,死亡2例。结论小儿下呼吸道肺炎克雷伯菌感染以年龄6个月内、合并有原发基础性疾病婴儿发病率高,且并发症多。ObjectiveTo explore clinical features and antimicrobial resistance of Klebsiella pneumoniae （K. pneumoniae） lower respiratory tract infection（LRTI） in children. MethodsClinical data of 107 children with K. pneumoniae LRTI confirmed by sputum culture from January to December 2015 were analyzed retrospectively. Results62.62% of children with LRTI were aged less than 6 months and 64.49% episodes occurred in autumn and winter. All cases had cough and 39 had fever, the main complications were type I respiratory failure, type Ⅱ respiratory failure, cardiac insufficiency, and electrolyte disturbance, 39 cases（36.45%） had complications involving two systems, 5 cases（4.67%）had complications involving three systems,47 cases （43.93%） met the diagnostic criteria of severe pneumonia. 43 cases （40.19%） had primary underlying diseases, the major were congenital heart disease, preterm and low birth weight, and malnutrition. Children with imipenemresistant bacteria infection were more prone to develop extrapulmonary complications than those with nonresistant pathogenic infection. The resistance rate of K. pneumoniae to amikacin was the lowest（9.35%）. 90 cases were recovered and markedly effective, 11 cases were effective, 4 cases were not healed and voluntarily discharged from hospital, and 2 cases died. ConclusionChildren aged less than 6 months and with underlying diseases are prone to develop LRTI, and complications are more.

关 键 词：儿童 下呼吸道感染 肺炎克雷伯菌 抗药性 微生物 耐药性 合理用药 

分 类 号：R181.32[医药卫生—流行病学]