65例肺炎克雷伯菌中枢神经系统感染患者的临床特征及病原菌耐药性分析  

Clinical characteristics and pathogen resistance analysis of 65 patients with central nervous system infection caused by Klebsiella pneumoniae

作　　者：王余成[1] 胡亚倩 杨大恒 曹彤[3] 周晋[3] WANG Yucheng;HU Yaqian;YANG Daheng;CAO Tong;ZHOU Jin(Department of Laboratory Medicine,Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210000,China;Department of Nosocomial Infection Management Medicine,Children s Hospital of Nanjing Medical University,Nanjing 210000,China;Department of Laboratory Medicine,Children s Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属脑科医院检验科,江苏南京210008 [2]南京医科大学附属儿童医院感染管理办公室,江苏南京210008 [3]南京医科大学附属儿童医院检验科,江苏南京210008

出　　处：《现代医学》2025年第2期218-222,共5页Modern Medical Journal

基　　金：南京市卫健委一般性项目(YKK23166);南京医科大学科技发展基金资助项目(NMUB2022047)。

摘　　要：目的:分析2018—2023年南京医科大学附属脑科医院、南京医科大学附属儿童医院65例肺炎克雷伯菌中枢神经系统感染患者的临床特征及病原菌的药敏试验结果,为肺炎克雷伯菌引起中枢神经系统感染的诊断及治疗提供参考依据。方法:回顾性收集2018年1月至2023年12月南京医科大学附属儿童医院及附属脑科医院患者中,临床症状符合中枢神经系统感染且脑脊液培养为肺炎克雷伯菌的患者的临床资料及药敏试验结果。结果:65例发生肺炎克雷伯菌中枢神经系统感染的患者中,1~6个月患儿共12例,占18.5%;>60岁患者26例,占40.0%;患者主要来自重症监护室、神经外科;有16例患有胶质瘤(24.6%)、13例患有脑积水(20.0%);耐碳青霉烯类肺炎克雷伯菌菌株对大多数抗生素的耐药率明显高于非CRKP菌株;CRKP组与非CRKP组在侵袭性操作、多联抗菌药物使用、外周血PCT>0.5μ·L^(-1)、脑脊液总蛋白>0.45·L^(-1)的差异有统计学意义。结论:肺炎克雷伯菌中枢神经系统感染常见于低龄患儿及老人,该类患者免疫力低,并伴有严重基础疾病,耐碳青霉烯类肺炎克雷伯菌耐药情况较为严重,临床应根据患者的临床特征和病原菌的药敏结果进行合理的治疗。Objective:The clinical features and drug susceptibility test results of 65 patients with central nervous system infection caused by Klebsiella pneumoniae in Brain Hospital Affiliated to Nanjing Medical University and Children’s Hospital of Nanjing Medical University from 2018 to 2023 were analyzed to provide reference for the diagnosis and treatment of central nervous system infection caused by Klebsiella pneumoniae.Methods:Clinical data and drug susceptibility test results of patients with clinical symptoms consistent with central nervous system infection and cerebrospinal fluid culture of Klebsiella pneumoniae in Children s Hospital and Brain Hospital Affiliated to Nanjing Medical University from January 2018 to December 2023 were retrospectively collected.Results:Among 65 cases of Klebsiella pneumoniae central nervous system infection,12 cases(18.5%)occurred from those aged 1 to 6 months.26 patients(40.0%)were>60 years old,mainly from the intensive care unit and neurosurgery department;There were 16 cases with glioma(24.6%)and 13 cases with hydrocephalus(20.0%);The resistance rate of carbapenem-resistant Klebsiella pneumoniae strains to most antibiotics was significantly higher than that of non-CRKP strains;There were statistically significant differences between CRKP group and non-CRKP group in invasive procedures,multi-antibiotic use,peripheral blood PCT>0.5μ·L^(-1),total protein of cerebrospinal fluid>0.45·L^(-1).Conclusion:Central nervous system infection of Klebsiella pneumoniae is common in young children and the elderly.Such patients have low immunity and are accompanied by serious underlying diseases,and carbapenem-resistant Klebsiella pneumoniae is even more serious.Clinical treatment should be reasonable according to the clinical characteristics of patients and the results of drug sensitivity of pathogens.

关 键 词：重症监护室 肺炎克雷伯菌 中枢神经系统感染 碳青霉烯耐药 

分 类 号：R446.5[医药卫生—诊断学]