新生儿肺炎克雷伯菌肺炎临床及耐药性分析  

Analysis on clinical manifestation and drug resistance of Klebsiella pneumoniae of neonates

作　　者：边程鹏[1] 张月[1] 庄晓玲[1] 石艳[1] BIAN Cheng-peng;ZHANG Yue;ZHUANG Xiao-ling;SHI Yan(Department of Pediatrics,the First People′s Hospital of Liangshan,Xichang,Sichuan 615000,China)

机构地区：[1]凉山州第一人民医院儿科,四川西昌615000

出　　处：《热带医学杂志》2020年第7期959-962,共4页Journal of Tropical Medicine

基　　金：四川省医学会科研青年创新课题(Q1501630)。

摘　　要：目的探讨新生儿肺炎克雷伯菌肺炎患儿临床表现及病原菌的耐药性。方法回顾性分析2013年7月至2018年7月在凉山州第一人民医院收治的新生儿肺炎中痰培养病原菌为肺炎克雷伯菌的患儿临床表现及该病原菌耐药情况,并对产超广谱β一内酰胺酶(ESBLs)菌和非产ESBLs菌耐药率进行比较分析。结果72例患儿中咳嗽、气促68例(94.44%),鼻阻45例(62.50%),发热38例(52.78%),口吐白沫37例(51.39%),双肺出现湿罗音58例(80.56%),胸片均支持肺炎,X线片示患儿存在有不同程度的散在点、片状阴影。72株肺炎克雷伯菌对哌拉西林、氨苄西林耐药率为84.6%~95.8%,对头孢噻肟、头孢曲松、头孢呋辛、头孢唑啉耐药率≥50%。耐碳青霉烯类3株,耐药率4.2%,此3株菌对环丙沙星敏感。72株菌中产ESBLs菌株35株,占48.6%;非产ESBLs菌株37株,占51.4%。产ESBLs肺炎克雷伯菌对氨苄西林、头孢噻肟、头孢曲松、头孢呋辛、头孢唑啉、哌拉西林、头孢吡肟高度耐药,耐药率达100%;对头孢他啶、氨曲南、哌拉西林/他唑巴坦、阿莫西林/克拉维酸钾耐药率(71.4%~77.1%)均高于非产ESBLs菌株(P<0.01)。产ESBLs菌和非产ESBLs菌对头孢西丁、环丙沙星、左氧氟沙星、阿米卡星、美洛培南对株耐药率均较低,且差异无统计学意义(P>0.05)。结论肺炎克雷伯菌耐药严重,产ESBLs菌株较多,出现耐碳青霉烯菌株。临床应及时行病原学检查及耐药性鉴定,以指导抗生素的合理使用。Objective To investigate the clinical manifestations and drug resistance of neonatal Klebsiella pneumoniae pneumonia.Method Clinical data of neonates with Klebsiella pneumoniae pneumonia from July 2013 to July 2018 in the First People′s Hospital of Liangshan were collected,and the drug resistance rate of non extended-spectrumβ-lactamases producing(non-ESBLs-producing)bacteria were retrospectively analyzed.Results 72 cases showed symptoms of coughing,68 cases(94.44%)of shortness of breath,45 cases(62.50%)of nasal obstruction,38 cases(52.78%)of fever,37 cases(51.39%)of foaming in the mouth,and 58 cases(80.56%)with wet rales in both lungs.Chest radiographs supported pneumonia in all cases.X-ray films showed that there were scattered points and patchy shadows in different degrees.The clinical manifestations of Klebsiella pneumoniae pneumonia were similar to those of other pathogenic bacteria.As for a total of 72 strains of Klebsiella pneumonia,the drug resistance rate of piperacilin and ampicillin were respectively84.6%-95.8%,drug resistance rate of cefotaxime,ceftriaxone,cefuroxime and cefazolin was over 50%;the drug resistance rate of 3 strains carbapenems-resistant Klebsiella pneumonia was 4.2%,but sensitive to ciprofloxacin.Among 72 strains,35 strains(48.6%)produced ESBLs and 37 strains(51.4%)were non-ESBLs-producing.ESBLs-producing Klebsiella pneumoniae were highly resistant to ampicillin,cefotaxime,ceftriaxone,cefuroxime,cefazolin,piperacillin,cefepime,and the drug resistance rate was 100%.The resistance rates of ceftazidime,aztreonam,piperacillin/halobacter and amoxicillin/clearance potassium(71.4%-77.1%)were higher than those of the non-ESBLs-producing strains(P<0.01).The resistance rates of ESBLs-producing and non-ESBLs-producing bacteria to cefoxitin,ciprofloxacin,levofloxacin,amikacin,and meropenem were low,and there was no statistically significant difference(P>0.05).Conclusions The resistance of Klebsiella pneumoniae to antibiotics was severe.Many strains procuded ESBLs,and carbapenem-resistant strain

关 键 词：新生儿 肺炎 病原菌 肺炎克雷伯菌 耐药性 

分 类 号：R378.996[医药卫生—病原生物学]