2017年至2020年昆明市儿童医院血流感染大肠埃希菌和肺炎克雷伯菌的耐药性  

Drug Resistance of Escherichia coli and Klebsiella pneumoniae in Children with Bloodstream Infection from 2017 to 2020

作　　者：黄海林[1] 蒋鸿超[1] 李小娟[1] HUANG Hai-lin;JIANG Hong-chao;LI Xiao-juan(Dept.of Clinical Laboratory,Kunming Children's Hospital,Kunming Yunnan 650228,China)

机构地区：[1]昆明市儿童医院检验科,云南昆明650228

出　　处：《昆明医科大学学报》2021年第8期95-100,共6页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(81960033);云南省中青年学术和技术带头人(202005AC160066);昆明市春城人才计划青年拔尖专项(C201914013)。

摘　　要：目的对昆明市儿童医院2017~2020年引起血流感染的大肠埃希菌和肺炎克雷伯菌耐药情况进行分析,为临床治疗儿童血流感染合理用药提供参考依据。方法收集昆明市儿童医院2017年1月至2020年12月间门诊和住院患儿临床诊断为菌血症,且血液标本培养为大肠埃希菌或肺炎克雷伯菌的血培养结果,用WHONET 5.6软件对原始数据进行统计学分析。结果从血培养阳性标本中共分离出大肠埃希菌193株,其中产超广谱β内酰胺酶(ESBLs)100株,阳性率为51.8%;耐碳青霉烯类大肠埃希菌(CR-ECO)8株,阳性率3.3%;肺炎克雷伯菌46株,其中产超广谱β内酰胺酶(ESBLs)18株,阳性率39.1%,耐碳青霉烯类肺炎克雷伯菌(CRKPN)14株,阳性率30.4%。大肠埃希菌和肺炎克雷伯菌产ESBLs菌株耐药率较非产ESBLs菌株高。CR-ECO对氨曲南耐药率为87.5%,环丙沙星、左氧氟沙星、复方新诺明耐药率为100%;CR-KPN对氨曲南耐药率为61.1%,环丙沙星、左氧氟沙星耐药率为44.4%,复方新诺明耐药率为5.6%。14株CR-KPN中有12株对亚胺培南MIC值≥16μg/mL,占85.7%(12/14);8株CR-ECO中有7株对亚胺培南MIC值≥16μg/mL,占87.5%(7/8)。分离菌株临床科室分布以新生儿病房最高,其次为血液肿瘤和重症监护病房;年龄以<28 d的新生儿居多,其次是>28 d~1岁。结论昆明市儿童医院新生儿病区、血液肿瘤、重症监护病区面临大肠埃希菌和肺炎克雷伯菌血流感染的困境,且菌株具有多重耐药性。这对临床治疗上述2种菌引起的血流感染,选用抗生素的压力也越来越困难,应高度重视。合理有效地控制感染,减少耐药菌株出现尤为重要。Objective To analyze the drug resistance of Escherichia coli and Klebsiella pneumoniae causing bloodstream infection in our hospital from 2017 to 2020,so as to provide reference for clinical treatment of children with bloodstream infection.Methods The blood culture results of outpatients and inpatient children with clinical diagnosis of bacteremia in our hospital from January,2017 to April,2020 were collected,and data were analyzed by WHONET 5.6 software.Results A total of 193 strains of Escherichia coli were isolated from blood culture positive samples,including 100 strains(51.8%)producing extended spectrum β-lactamases(ESBLs),8 strains(3.3%)of carbapenem resistant Escherichia coli(CR-ECO).There were 46 strains of Klebsiella pneumoniae,including 18 strains(39.1%)producing extended spectrum beta lactamases(ESBLs),and 14 strains(30.4%)of carbapenem resistant Klebsiella pneumoniae(CR-KPN).The resistance rate of ESBLs producing strains of Escherichia coli and Klebsiella pneumoniae was higher than that of non-ESBLs producing strains.The resistance rate of CR-ECO to aztreonam was 85.7%,and the resistance rates to ciprofloxacin,levofloxacin and cotrimoxazole were 100%;The resistance rate of CR-KPN to aztreonam was 61.1%,the resistance rates to ciprofloxacin,levofloxacin was 44.4%,and the resistance rate to cotrimoxazole was 5.6%.The MIC value of imipenem in 12 CR-KPN strains were greater than 16 μg/mL,accounting for 85.7%(12/14).The MIC value of imipenem in 7 CR-ECO strains were greater than 16 μg/mL,accounting for 87.5%(7/8).The highest distribution of isolated strains in clinical departments was in neonatology department,followed by hematology tumor and intensive care unit;most of the newborns aged<28 days,followed by>28 days to 1 year old.ConclusiOn The neonatal ward,hematological oncology and intensive care unit of our hospital have higher prevelance of bloodstream infection of multiple drug resistant Escherichia coli and Klebsiella pneumoniae.These infections are difficult to treat,which is an issure we should

关 键 词：血流感染 大肠埃希菌 肺炎克雷伯菌 耐药性 

分 类 号：R373.2[医药卫生—病原生物学]