仙居县儿童下呼吸道感染肺炎克雷伯菌耐药性分析

目的分析仙居人民医院住院下呼吸道感染患儿临床分离肺炎克雷伯菌的耐药特征，为临床合理用药提供依据。方法选择2012年7月至2013年7月该院下呼吸道感染肺炎克雷伯菌阳性患儿81例。对患儿的临床一般资料进行分析，对临床分离菌株进行细菌鉴定，用18种抗生素进行药敏试验，采用WHONET5．4分析软件进行统计。结果2012年7月至2013年7月共分离出81株肺炎克雷伯菌，ESBLs阳性42株，检出率为51．85％。所有菌株对亚胺培南、厄他培南、左旋氧氟沙星、丁胺卡那100％敏感。对氨苄西林耐药率为100％。ESBLs阴性菌株对氨曲南、头孢曲松、头孢他啶、头孢唑啉、头孢吡肟100％敏感，而ESBLs阳性菌株则100％耐药。ESBLs阴性菌株对其他抗生素的耐药率为氨苄西彬舒巴坦（12．82％）、环丙沙星（2．56％）、头孢替坦（O％）、呋喃妥因（20．51％）、庆大霉素（5．13％）、复方新诺明（17．85％）、妥布霉素（2．56％）、哌拉西林／他唑巴坦（2．56％）；ESBLs阳性菌株对其他抗生素的耐药率为氨苄西林／舒巴坦（73．80％）、环丙沙星（2．38％）、头孢替坦（16．67％）、呋喃妥因（61．90％）、庆大霉素（28．57％）、复方新诺明（54．76％）、妥布霉素（7．14％）、哌拉西林／他唑巴坦（7．14％）。结论本地区患儿中肺炎克雷伯菌耐药性较高，临床应重视病原菌的检测。

The susceptibility analysis of Klebsiella pneumoniae isolated from children with lower respiratory tract infections in Xianju County

Objective To analyze the resistant characteristics of KlebsieUa pneumoniae isolated from Lower respira- tory tract infection children inpatients in our hospital, and provide basis for clinical rational use of antimicrobial agents. Methods 81 cases of lower respiratory tract infection children patients infected by Klebsiella prteurnoniae in People＇s Hospital of Xianju County from July 2012 to July 2013 were selected. Clinical general information of the children patients was analyzed. The identification of the isolates was performed, and their drug sensitivity against 18 kinds of antibiotics were detected. Statistical analysis was done by using WHONET 5.4 software. Results The rate of ESBL-producing K. pneumoniae was 51.85 %. All strains were sensitive to imipenem, ertapenem, levofloxa- ein and amikaein. ESBLs-producing strains were highly resistant to cephalosporins, while the resistance rates to ciprofloxacin, piperacillin/tazobactam and Cefotetan were still lower at 2.43%, 7.3t %, and 17.07% respectively. Non-ESBL-producing strains were significantly sensitive to cephalosporin, fluoroquinolones, and aminoglycosides, with the sensitivity rates over 80%. Conclusion The resistance of Ko pneumoniae isolated from children is high in our region; Detection of pathogens should paid more attention.