儿科重症监护病房呼吸机相关性肺炎患儿肺炎克雷伯菌耐药性分析

摘要

目的 分析儿科重症监护病房(PICU)呼吸机相关性肺炎(VAP)患儿肺炎克雷伯菌耐药性.方法 选取2014年3月—2016年8月于宝鸡市妇幼保健院PICU行机械通气治疗的患儿610例,根据VAP发生情况分为感染组159例与未感染组451例.比较两组患儿临床资料,并进行药敏试验以分析肺炎克雷伯菌耐药性.结果 本组患儿VAP发生率为26.07％ (159/610).两组患儿性别、入住PICU前住院时间、糖皮质激素使用率、抑酸剂使用率比较,差异无统计学意义(P＞0.05);两组患儿PICU入住时间、机械通气时间、抗菌药物种类、分化簇3(CD3)细胞数比较,差异有统计学意义(P＜0.05).感染组患儿共检出肺炎克雷伯菌182株,其中超广谱β-内酰胺酶(ESBLs)阳性菌株64株,阳性率为35.16％.肺炎克雷伯菌对青霉素耐药率为100.00％,对氨苄西林、头孢噻肟、头孢曲松、头孢唑林的耐药率均＞ 70.00％,对亚胺培南的耐药率最低,为26.92％.ESBLs阳性肺炎克雷伯菌对头孢噻肟、头孢他啶、头孢吡肟的耐药率高于ESBLs阴性肺炎克雷伯菌,对头孢唑林的耐药率低于ESBLs阴性肺炎克雷伯菌(P＜0.05).结论 PICU VAP患儿肺炎克雷伯菌耐药率较高,应结合患儿具体情况及药敏试验结果合理选用抗菌药物.%Objective To analyze the antibiotic resistance of Klebsiella pneumoniae in children with ventilator-associated pneumonia (VAP) in pediatric intensive care unit (PICU).Methods From March 2014 to August 2016,a total of 610 children undergoing mechanical ventilation were selected in PICU,Maternal and Child Care Service Center of Baoji,and they were divided into infection group (n =159) and non-infection group (n =451).Clinical data was compared between the two groups,and antimicrobial susceptibility test was carried to analyze the antimicrobial susceptibility test.Results The incidence of VAP was 26.07％ (159/610).No statistically significant differences of gender,hospital stays before admission of PICU,utilization rate of glucocorticoids or antacids was found between the two groups (P ＞ 0.05),while there were statistically significant differences of PICU stays,duration of mechanical ventilation,kinds of antibacterial agents and CD3 cell counts (P ＜ O.05).A total of 182 strains of Klebsiella pneumoniae were cultivated out,including 64 ESBLs positive strains (accounting for 35.16％).The to penicillin was 100.00％,to ampicillin,cefotaxime,ceftriaxone and cephazolin were all over 70.00％,to imipenem was 26.92％ (the lowest).Antibiotic resistant rate of ESBLs positive Klebsiella pneumoniae to cefotaxime,ceftazidime and cefepime was statistically significantly higher than that of ESBLs negative Klebsiella pneumoniae,respectively,while antibiotic resistant rate of ESBLs positive Klebsiella pneumoniae to cephazolin was statistically significantly lower than that of ESBLs negative Klebsiella pneumoniae (P ＜ 0.05).Conclusion Antibiotic resistant rate of Klebsiella pneumoniae is relatively high in children with VAP in PICU,we should choose rationalantibacterial agents according to the child's specific circumstance and antimicrobial susceptibility test results.