【摘要】 目的探讨新生儿肺炎克雷伯菌感染的临床特点及药敏情况,以及产超广谱β-内酰胺酶(Extended-spectrumβ-lactamases,ESBLs)即ESBLs阳性菌的发生率,从而指导临床如何合理用药及采取相应临床措施。方法回顾分析89例经咽拭子、痰、尿及血液培养确诊为肺炎克雷伯菌院内感染的新生儿临床资料、细菌药敏试验结果。结果肺炎克雷伯菌感染的常见部位为呼吸道,其次为血流感染及泌尿道感染。培养出的89例肺炎克雷伯菌其中有52株(58.4%)产ESBLs,对头孢噻肟、头孢吡肟、头孢他啶耐药率高达79%~100%,明显高于ESBLs阴性组;对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦加酶抑制剂药物耐药率低;对亚胺培南、复方新诺明、左氧氟沙星普遍敏感。结论新生儿肺炎克雷伯菌感染首选药物为哌拉西林/他唑巴坦、头孢哌酮/舒巴坦加酶抑制剂类药物,重症患儿首选碳青霉烯类药物。临床医师应根据药敏试验结果选用抗生素,以减少ESBLs菌株的产生。更多还原

【Abstract】 Objective To investigate the clinical features and susceptibility of Klebsiella pneumoniae infection in neonates,as well as extended-spectrum β-lactamases( ESBLs) incidence so as to guide the clinical rational drug use and take appropriate clinical measures. Methods Retrospective analysis was made on the clinical data of 89 neonatals with pharyngeal swab,sputum,urine and blood culture diagnosed with Klebsiella pneumonia bacteria nosocomial infection and bacterial susceptibility test results. Results Klebsiella pneumoniae infection occurred mostly in respiratory tract,followed by bloodstream infections and urinary tract infections. Of the cultivated 89 cases of Klebsiella pneumoniae,52( 58. 4%) produced extended-spectrum β-lactamases( ESBLs),cefotaxime,cefepime,ceftazidime resistance rates were as high as 79% ~ 100%,which were significantly higher than those in ESBLs negative group; piperacillin / tazobactam,cefoperazone / Shuba Tanga inhibitor drug resistance was low,and were generally sensitive to imipenem,sulfamethoxazole,levofloxacin. Conclusion The preferred neonatal drug against Klebsiella pneumoniae infection are piperacillin / tazobactam,cefoperazone / Shuba Tanga inhibitor class of drugs, and carbapenems for children in severe cases. Clinicians should consider susceptibility testing results in selecting antibiotics to reduce the generation of ESBLs strains.更多还原