儿童感染肺炎克雷伯菌的耐药及流行性分析  

Drug resistance and epidemiological analysis of klebsiella pneumoniae in pediatric pneumonia cases

作　　者：贾静[1] 郭明发 高美玲[1] 杨冰 解海珍 徐璐[1] JIA Jing;GUO Ming-fa;GAO Mei-ling;YANG Bing;JIE Hai-zhen;XU Lu(Department of Clinical Laboratory,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou Key Laboratory of Children's Infection and Immunology,Zhengzhou 450000,Henan,China;不详)

机构地区：[1]郑州大学附属儿童医院检验科、郑州市儿童感染与免疫重点实验室,河南郑州450000 [2]郑州大学附属儿童医院血液肿瘤科,河南郑州450000

出　　处：《广东医学》2025年第3期444-448,共5页Guangdong Medical Journal

基　　金：河南省儿童感染性疾病国际联合实验室开放课题(GR202201)。

摘　　要：目的分析儿童患者检出的肺炎克雷伯菌(KP)的耐药性及流行性,为临床抗菌药物使用提供参考依据。方法运用WHONET5.6软件回顾性分析2015年1月至2022年12月感染患儿分离的KP不同标本类型、不同科室、不同年龄之间的流行趋势,重点分析产超广谱β内酰胺酶(ESBLs)KP和耐碳青霉烯类肺炎克雷伯菌(CRKP)耐药率的差异性。结果2015年1月至2022年12月共收集分离菌3862株,主要来源为痰液标本(76.1%),其次血液标本(7.1%),脓液标本(5.7%),肺泡灌洗液(4.2%);重症监护室(ICU)是病原菌主要检出科室(46.4%),其次新生儿科(14.7%),小婴儿科(14.0%),ICU检出菌株对抗菌药物的耐药率与其他科室相比差异有统计学意义(P<0.001)。所有菌株检出产ESBLs菌948株(25.4%),CRKP菌1647株(42.6%),CRKP检出率高于产ESBLs菌,CRKP和产ESBLs菌株对氨曲南、环丙沙星、左氧氟沙星、阿米卡星耐药率分别为:94.6%/63.6%,84.4%/19.0%,82.5%/13.5%,65.1%/4.3%,CRKP表现出较高的耐药性,而CRKP对复方磺胺甲噁唑耐药率较低(21.1%);2015—2022年检出的KP对头孢类抗生素耐药率有逐年下降趋势,而对碳青霉烯类抗生素耐药率基本保持在40%左右,但在2022年出现明显下降(22.9%);8年间所收集的KP对多黏菌素仍保持较高的敏感性,耐药率低于5%。结论KP主要检出于ICU,CRKP的高检出率增加了临床抗感染治疗的难度,因此加强对KP耐药性监测势在必行,尤其是对高级抗生素的管理,可减少CRKP菌株的产生,同时依据流行病学调查控制院内感染的爆发。Objective To analyze the drug resistance and epidemiology of Klebsiella pneumoniae(KP)isolated from pediatric patients in our hospital,providing reference for the clinical use of antibiotics.Methods A retrospective analysis was performed using WHONET5.6 software to assess the trend of KP isolation from different specimen types,departments,and age groups from January 2015 to December 2022.Special attention was given to the resistance rates of extended-spectrum beta-lactamase(ESBLs)-producing KP and carbapenem-resistant Klebsiella pneumoniae(CRKP).Results From January 2015 to December 2022,a total of 3,862 strains were isolated.The majority of these came from sputum samples(76.1%),followed by blood(7.1%),pus(5.7%),and bronchoalveolar lavage fluid(4.2%).The Intensive Care Unit(ICU)was the main department where KP was detected(46.4%),followed by the neonatal department(14.7%)and pediatric department(14.0%).The drug resistance rate of bacterial strains isolated in the ICU showed significant differences compared to other departments(P<0.001).Of all strains,948(25.4%)produced ESBLs,and 1,647(42.6%)were CRKP.The detection rate of CRKP was higher than that of ESBLs-producing strains.Resistance rates of CRKP and ESBLs-producing strains to various antibiotics were as follows:amikacin(94.6%/63.6%),ciprofloxacin(84.4%/19.0%),levofloxacin(82.5%/13.5%),and amikacin(65.1%/4.3%).CRKP exhibited higher resistance compared to ESBLs-producing strains,although CRKP showed relatively lower resistance to sulfamethoxazole/trimethoprim(21.1%).From 2015 to 2022,the resistance of KP to cephalosporins showed a downward trend,while resistance to carbapenems remained stable around 40%,with a significant drop in 2022(22.9%).KP remained highly sensitive to polymyxins,with a resistance rate of less than 5%.Conclusion KP strains in our hospital are primarily isolated from the ICU,with a high detection rate of CRKP,which increases the difficulty of clinical antimicrobial therapy.Strengthening the monitoring of KP resistance is crucial,particularly

关 键 词：儿童 肺炎克雷伯菌 重症监护室 

分 类 号：R725[医药卫生—儿科] R372[医药卫生—临床医学]