儿童肺炎克雷伯杆菌下呼吸道感染临床分布及耐药性分析.docVIP

儿童肺炎克雷伯杆菌下呼吸道感染临床分布及耐药性分析（广西贵港市妇幼保健院检验科 广西 贵港537100） 【摘要】目的:探讨儿童肺炎克雷伯杆菌急性下呼吸道感染（ALRTIS）的临床分布特点及耐药情况。方法:2008年1月―2009年8月住院的860例ALRTs患儿进行痰液细菌培养，用K-B纸片扩散法进行药物敏感试验，同时对肺炎克雷伯杆菌进行超广谱β内酰胺酶（ESBLS）表型筛选及确证试验。结果:本组共培养出细菌242例，其中肺炎克雷伯杆菌45株，产ESBLS 12株（26.67%），产ESBLS对头孢曲松耐药率100%，对头孢吡肟、头孢他啶、氨苄西林/舒巴坦耐药率为83.3%；对环丙沙星、加替沙星、左氧氟沙星、亚胺培南、哌拉西林/他唑巴坦高度敏感。1岁以内婴儿患者肺炎克雷伯杆菌的感染率（82.2%）明显高于1岁以上患者（17.8%）。 结论:婴幼儿是肺炎克雷伯杆菌的易感人群，临床用药应根据药物敏感试验结果合理选择抗菌药，减少耐药菌株的产生。 【关键词】克雷伯杆菌;下呼吸道感染;儿童 Clinical distribution and Drug Resistance of Acute Lower Respiratory Tract infections of Klebsiella Pneumoniae in Children Zhong weimingHe haoyuHuang jialiang 【Abstract】ObjiectiveTo investigate the clinical characteristics and drug resistance of acute lower respiratory tract infections（ALRTIs） caused by Klebsiella pneumoniae（Kp） in children. Methods We performed drug sensitivity test by disc diffusion method, extended spectrum β lactamases（ESBLs） phenotype screening, and verification test on Kp strains obtained from sputum specimens of children with ALRTIs who were admitted in our hospital from between January 2008 to August 2009.ResultsTotally 242 bacterial strains were identified,among which 45 were Kp（including 12 ESBLs-producing Kp）. The resistance rate of ESBLs-producing Kp strains were 100% to ceftriaxone and 83.3% to cefepime,ceftazidime and ampicillin. ESBLs-producing strains were highly susceptible to ciprofloxacin,Gatifloxacin,Lev-ofloxacin,imipenem and piperacillin/tazobatam.The incidence of ALRTIs caused by Kp significantly higher in children under the age of one year than in those older zhan one year.ConclusionInfants are more susceptible to Kp.The clinicians select legitimately antibiotics according to results of drug sensitivity test, so decrease the occurrence of drug resistant strains. 【Key words】Klebsiella pneumoniae; Lower respiratory tract infections; Child 【中图分类号】R378.23【文献标识码】A【文章编号】1008-6455（2011）06-0003-02 肺炎克雷伯杆菌是革兰阴性杆菌，常寄生于呼吸道，是引起医院获得性肺炎等下呼吸道感染的重要病原菌。近几年来，随着临床上大量使用广谱抗生素，由该菌引起医院