1997-2010年小儿肺炎克雷伯菌耐药性变迁分析

目的 了解1997-2010年肺炎克雷伯菌(KPN)在儿科及新生儿科临床感染中的流行状况及耐药性.方法 收集珠海市妇幼保健院儿科及新生儿科1997-2010年临床痰液标本中分离的肺炎克雷伯菌共633株,分析其对常用抗生素的耐药性.并分析2005年以后产超广谱β-内酰胺酶(ESBLs)与不产ESBLs肺炎克雷伯菌株耐药性的差异.结果 根据14年来该院临床分离的肺炎克雷伯菌药敏试验结果显示,该菌对氨苄西林及哌拉西林的耐药率最高,可达100％.对头孢他啶、头孢吡肟的耐药率各年有波动,但总体无明显变化(分别约28％、34％).对儿科临床限制使用药物如庆大霉素、左旋氧氟沙星、氯霉素、复方新诺明等耐药率呈逐年下降趋势.14年来尚未发现对亚胺培南耐药的KPN.2005年以后产ESBLs菌株的检出率呈逐年增高趋势(17％ ～38.7％),且对各种抗生素的耐药率较普通KPN明显增高.结论 肺炎克雷伯菌对临床常用β-内酰胺类抗生素耐药率高,儿科限制使用药物的耐药率有逐年下降趋势,产ESBLS菌株耐药情况严重.

Changes in antimicrobial resistance of Klebsiella pneumoniae in children 1997-2010

Objective To investigate the prevalence and the trend of drug resistance of Klebsiella pneumoniae in children 1997-2010.Methods 633 strains of K.pneumoniae isolated from sputum samples during 1997-2010 were collected and their antimicrobial resistance was detected.The diffrences of antimicrobial resistance between ESBLs-producing K.pneumoniaeS and non-ESBLs producing ones.Results The resistance rate to Piperacillin was the highest,nearly 100%,while those to Ceftazidime and Cefepime were lower.The resistance rates to the drugs that were restricted for pediatric patients such as Gentamycin,Levofloxacin,Chloramphenicol and Trimesulf,were decreasing yearly.Carbapenems(Imipenem) was the most active agent against K.pneumoniae,no resistance strain was found.The detection rate of ESBLs-producing K.pneumoniae had increased since 2005,and its drug resistance was at a higher level than that ofthe non-ESBLs producing ones.Conclusion K.pneumoniae counteracts β-lactam commonly used.The resistance rate to the pediatric-restricted drugs is decreasing year by year.More severe the trend of ESBLs-producing K.pneumoniae resistance is.