4例儿童肺炎克雷伯菌脑膜炎的临床特征及耐药性分析  

Clinical Features and Drug Resistance of Klebsiella Pneumoniae Meningitis in 4 Children

作　　者：竺婷婷[1] 旷凌寒[1] 王丽媛[1] 于凡[1] 张鸽[1] 麦佳 江咏梅[1] Zhu Tingting;Kuang Linhan;Wang Liyuan(Department of Laboratory Medicine,Department of Pediatric Neurology and Gastroenterology,Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,West China Second Hospital of Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西第二医院检验科消化科出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041

出　　处：《四川医学》2022年第11期1102-1107,共6页Sichuan Medical Journal

摘　　要：目的回顾性分析儿童肺炎克雷伯菌(Kp)的脑膜炎临床特征及耐药性,以期帮助临床进行早期诊断和提高经验性治疗的准确性。方法纳入2018年1月至2021年2月我院细菌性脑膜炎(BM)患者中Kp脑膜炎患者临床资料及耐药情况。结果4354例全血或脑脊液标本,有菌生长121例,阳性率2.78%,其中4例Kp,占3.31%。3例(75%)存在致病高危因素:呼吸机、引流管、PICC导管置入和早产儿史。Kp脑膜炎患者以发热、呕吐为主要表现,均无脑膜刺激征及意识障碍,均存在头颅影像学异常。多数菌株对青霉素类及头孢类抗生素耐药,对氨基糖苷、多黏菌素、磺胺及喹诺酮类药物敏感。4例患者均发生并发症,1例死亡,死亡率25%。结论儿童Kp脑膜炎存在致病高危因素的比例高,临床特征不典型,预后不良,死亡率高。儿童Kp脑膜炎中Kp菌株对多黏菌素、磺胺及喹诺酮类敏感。Objective Clinical characteristics and drug resistance of Klebsiella pneumoniae meningitis(Kp)in children were retrospectively analyzed in order to help clinical early diagnosis and improve the accuracy of empirical treatment.Methods The clinical data and drug resistance of Kp meningitis patients with pediatric bacterial meningitis(BM)in our hospital from January 2018 to February 2021 were collected and analyzed.Results Among 4354 samples of blood or cerebrospinal fluid(CSF),121 cases had bacterial growth,the positive rate was 2.78%,among which 4 cases were Kp,accounting for 3.31%.Three patients(75%)had risk factors:ventilator,drainage tube,Peripherally Inserted Central Catheter(PICC)catheter placement and a history of premature birth.The main manifestations of Kp meningitis patients were fever and vomiting,without meningeal irritation or disturbance of consciousness,and with cranial imaging abnormalities.Most of them were resistant to penicillin and cephalosporin antibiotics,but sensitive to aminoglycoside,polymyxins,sulfa and quinolones.Complications occurred in all 4 patients,and 1 died,with a fatality rate of 25%.Conclusions Kp meningitis in children has features of high risk factors,atypical clinical characteristics,poor prognosis and high mortality.Kp strains of Kp meningitis in children are sensitive to polymyxins,sulfonamides and quinolones.

关 键 词：肺炎克雷伯菌 脑膜炎 儿童 

分 类 号：R725.6[医药卫生—儿科]