新生儿肺炎克雷伯菌败血症的临床分析(1)
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【摘要】 目的 探讨新生儿肺炎克雷伯菌败血症的临床特点及药敏特点,为早期诊治提供依据。方法 对本院新生儿科30例确诊为肺炎克雷伯菌败血症的新生儿进行临床资料及药敏结果的回顾性分析。结果 肺炎克雷伯菌败血症常可引起多脏器功能受损。30株肺炎克雷伯菌中检出产ESBLs菌株8株(占26.7%),非产ESBLs菌株22株(占73.3%)。肺炎克雷伯菌对亚胺培南、阿米卡星敏感率达100%,对环丙沙星和庆大霉素的敏感率分别为90%及70%。肺炎克雷伯菌对大多数青霉素类及头孢菌素类药物不敏感。结论 肺炎克雷伯菌败血症发病有增多趋势,且多为医院内感染,有部分为产超广谱β 内酰胺酶菌株,耐药性强,对常用的抗生素不敏感,应根据药敏试验结果应用抗生素,以提高临床治愈率。
【关键词】新生儿; 败血症; 肺炎克雷伯菌
A clinical analyses of neonatal sepsis caused by Klebsiella pneumoniae
ZENG Le hui.Department of Pediatrics,the centen hospital of Yiyang city in Hunan Province ,Yiyang,413000,China
【Abstract】 Objective To study the clinical characteristics and the drug sensitivity of neonatalsepticemia caused by Klebsiella pneumoniae in order to provide the evidences for the diagnosis and treatment.Methods A retrospective analysis including clinical data and drug sensitivity results was made in 30 neonates with septicemia caused by Klebsiella pneumoniae.Results Neonatal septicemia caused by Klebsiella pneumoniae could be damaging to many organs.There were 8 ESBLs strains in 30 Klebsiella pneumoniae strains(was 26.7%),and 22 are negative ESBLs starins(was 73.3%).It was 100%of the Klebsiella pneumoniae strains were sensitive to carbapenems such as inipenem and panipenem,but there were 90%and 70%to each gentamicin and ciprofloxacin.Klebsiella pneumoniae were not sensitve to much of penicillin and cephalosporin.Conclusion The incidence of neonatal septicemia caused by Klebsiella pneumoniae wes higher than ever,and many of them were infected in hospital.Part of them were extended ESBLs and insensitive to the commonly used antibiotices.It is suggested the antibiotics should be used according to drug senitivity.
【Key words】 Neonate; Septicemia; Klebsiella pneumoniae
近几年来,在新生儿败血症的致病菌中肺炎克雷伯菌(KlebsieUa pneumoniae,KP)有所增加。此菌有一部分属于产超广谱β 内酰胺酶(ESBLs)菌株,这部分菌株对青霉素类和头孢菌素类抗生素耐药率较高,给临床治疗带来较大困难。为了进一步掌握新生儿肺炎克雷伯菌败血症的特点、指导临床早期诊治,现将本院新生儿科近年来收治的30例肺炎克雷伯菌败血症资料总结分析如下。
1 资料与方法
1.1 一般资料 以本院新生儿科2004年1月至2009年5月期间收治的新生儿肺炎克雷伯菌败血症30例为研究对象,所有病例的诊断均符合“新生儿败血症诊疗方案”[1],血培养均有肺炎克雷伯菌生长。30例患儿中男17例,女13例。足月儿19例,早产儿11例。发病最早为生后3 d,最晚为生后25 d。发病日龄≤5 d 6例,6~10 d 13例,>10 d 11例。孕妇产前有发热史4例,胎膜早破5例,羊水I度污染4例,出生时轻度窒息5例,在家中分娩3例,医院分娩27例 ......
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