住院儿童肺炎克雷伯菌感染情况及耐药分析
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摘要
目的:探讨住院儿童肺炎克雷伯菌的感染情况及耐药分析,比较黏液型和非黏液型肺炎克雷伯菌的耐药情况,为临床医生合理用药提供临床指导。方法:回顾性收集肇庆市端州妇幼保健院2015年1月至2016年12月期间内普遍感染性疾病住院儿童标本中分离的155株肺炎克雷伯菌,筛选黏液型肺炎克雷伯菌,比较黏液型与非黏液型肺炎克雷伯菌对抗菌药物敏感性,使用WHONET 5.6统计分析肺炎克雷伯菌对抗菌药物的敏感性。结果:获得56株黏液型肺炎克雷伯菌,肺炎克雷伯菌对庆大霉素、妥布霉素、美罗培南、亚胺培南、阿米卡星及头孢哌酮/舒巴坦的敏感性都≥75%,黏液型分别为93.0%,92.9%,100.0%,94.6%,98.2%,89.3%,非黏液型分别为81.8%,79.8%,96.0%,74.7%,96.0%,71.7%。结论:非黏液型肺炎克雷伯菌对多种抗菌药物(庆大霉素、阿米卡星、美罗培南除外)的耐药率高于黏液型肺炎克雷伯菌,临床治疗应该要充分考虑生物膜对抗菌药物的影响以及儿童可使用的抗菌药物种类,合理联合用药进行治疗。
Objective:To investigate the infection status and drug resistance of Klebsiella pneumoniae in hospitalized children, and to compare the drug resistance between mucoid and non mucoid strains of Klebsiella pneumoniae, so as to provide clinical guidance for clinical rational use of drugs. Methods: A retrospective study was conducted to collect the 155 strains of Klebsiella pneumoniae isolated from the samples of hospitalized children with common infectious diseases in Maternal and Child Health Care Hospital in Duanzhou District of Zhaoqing City from January 2015 to December 2016. Klebsiella pneumoniae mucus type was screened, and the sensitivity of klebsiella pneumoniae mucus type and non-mucus type to antibiotics was compared. WHONET 5.6 was used to statistically analyze the sensitivity of klebsiella pneumoniae to antibiotics. Results: 56 strains of Klebsiella pneumoniae were obtained. The sensitivity of klebsiella pneumoniae to gentamicin, tobramycin, meropenem, imipenem, amikacin and cefoperazone/sulbactam was equal to or greater than 75 %. The mucous types in sensitivity were 93.0 %, 92.9 %, 100.0 %, 94.6 %, 98.2 %, 89.3 %, respectively. The non-mucous types in sensitivity were 81.8 %, 79.8 %, 96.0 %, 74.7 %, 96.0 %, 71.7 %, respectively. Conclusion: The drug resistance rate of Klebsiella pneumoniae of non-mucous type on a variety of antibiotics(except gentamicin, amikacin and meropenem) is higher than that of klebsiella pneumoniae of mucous type. In clinical treatment, the influence of biofilm on antibiotics and the types of antibiotics available for children should be fully considered, and rational combination of drugs should be used for treatment.
Objective:To investigate the infection status and drug resistance of Klebsiella pneumoniae in hospitalized children, and to compare the drug resistance between mucoid and non mucoid strains of Klebsiella pneumoniae, so as to provide clinical guidance for clinical rational use of drugs. Methods: A retrospective study was conducted to collect the 155 strains of Klebsiella pneumoniae isolated from the samples of hospitalized children with common infectious diseases in Maternal and Child Health Care Hospital in Duanzhou District of Zhaoqing City from January 2015 to December 2016. Klebsiella pneumoniae mucus type was screened, and the sensitivity of klebsiella pneumoniae mucus type and non-mucus type to antibiotics was compared. WHONET 5.6 was used to statistically analyze the sensitivity of klebsiella pneumoniae to antibiotics. Results: 56 strains of Klebsiella pneumoniae were obtained. The sensitivity of klebsiella pneumoniae to gentamicin, tobramycin, meropenem, imipenem, amikacin and cefoperazone/sulbactam was equal to or greater than 75 %. The mucous types in sensitivity were 93.0 %, 92.9 %, 100.0 %, 94.6 %, 98.2 %, 89.3 %, respectively. The non-mucous types in sensitivity were 81.8 %, 79.8 %, 96.0 %, 74.7 %, 96.0 %, 71.7 %, respectively. Conclusion: The drug resistance rate of Klebsiella pneumoniae of non-mucous type on a variety of antibiotics(except gentamicin, amikacin and meropenem) is higher than that of klebsiella pneumoniae of mucous type. In clinical treatment, the influence of biofilm on antibiotics and the types of antibiotics available for children should be fully considered, and rational combination of drugs should be used for treatment.
引文
[1] 王莲慧,魏丹丹.高毒力荚膜血清型肺炎克雷伯菌克隆株毒力和耐药性的研究[J].中华检验医学杂志,2016,39(4):286-290.
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[9] 詹志晖,欧立平.反复呼吸道感染与儿童免疫功能的相关性分析[J].中国社区医师:医学专业,2012,14(10):277-278.
[10] 吴泽刚,李艳,夏尊恩,等.儿童呼吸道感染后免疫功能指标的分析[J].职业与健康,2011,27(17):2032-2033.
[11] 何足元,陈志敏.医院内感染和社区感染儿童肺炎克雷伯杆菌临床特点及耐药性分析[J].重庆医学,2013,42(36):4382-4384.
[12] 杨朵,马冬媛,王松雪,等.肺炎克雷伯菌生物膜与细菌耐药性的关系分析[J].中华医院感染学杂志,2013,23(12):2785-2851.
[13] 穆小萍,唐玲玲,纪存委,等.阿奇霉素联合亚胺培南对肺炎克雷伯菌生物膜的抑制作用[J].中国抗生素杂志,2015,40(8):617-620.
[2] Shon AS,Bajwa RP,Russo TA.Hypervirulent(hypermucoviscous)Klebsiella pneumoniae:a new and dangerous breed[J].Virulence,2013,4(2):107-118.
[3] 黄国盛,廖燕,毕雷,等.新生儿重症监护病房医院感染临床特点及危险因素分析[J].中国新生儿科杂志,2011,26(5):304-307.
[4] 罗玉琳,黎雪梅,张小蓉,等.儿童医院感染多因素分析与健康教育干预研究[J].中华医院感染学杂志, 2013,23(18):4452-4453.
[5] 陈东科,孙长贵.实用临床微生物学检验与图谱[M].北京:人民卫生出版社,2011:329-330.
[6] 沈定霞,李东冬,郭玲,等.高黏液表型肺炎克雷伯菌的荚膜分型与毒力基因的检测[J].中华检验医学杂志,2014,37(5):374-377.
[7] Pan YJ,Fang HC,Yang HC,et al.Capsular polysaccharide synthesis regions in Klebsiella pneumoniae serotype K57 and a new capsular serotype[J].J Clin Microbiol,2008,46(7):2231-2240.
[8] Johnson JG,Murphy CN,Sippy J,et al.Type 3 fimbriae and biofilm formation are regulated by the transcriptional regulators MrkHI in Klebsiella pneumoniae[J].JBacteriol,2011,193(14):3453-3460.
[9] 詹志晖,欧立平.反复呼吸道感染与儿童免疫功能的相关性分析[J].中国社区医师:医学专业,2012,14(10):277-278.
[10] 吴泽刚,李艳,夏尊恩,等.儿童呼吸道感染后免疫功能指标的分析[J].职业与健康,2011,27(17):2032-2033.
[11] 何足元,陈志敏.医院内感染和社区感染儿童肺炎克雷伯杆菌临床特点及耐药性分析[J].重庆医学,2013,42(36):4382-4384.
[12] 杨朵,马冬媛,王松雪,等.肺炎克雷伯菌生物膜与细菌耐药性的关系分析[J].中华医院感染学杂志,2013,23(12):2785-2851.
[13] 穆小萍,唐玲玲,纪存委,等.阿奇霉素联合亚胺培南对肺炎克雷伯菌生物膜的抑制作用[J].中国抗生素杂志,2015,40(8):617-620.