89例新生儿肺炎克雷伯菌感染特征及药敏分析

目的探讨新生儿肺炎克雷伯菌感染的临床特点及药敏情况，以及产超广谱B-内酰胺酶（Extended—spec．trumB—lactamases，ESBLs）即ESBLs阳性菌的发生率，从而指导临床如何合理用药及采取相应临床措施。方法回顾分析89例经咽拭子、痰、尿及血液培养确诊为肺炎克雷伯菌院内感染的新生儿临床资料、细菌药敏试验结果。结果肺炎克雷伯菌感染的常见部位为呼吸道，其次为血流感染及泌尿道感染。培养出的89例肺炎克雷伯菌其中有52株（58．4％）产ESBLs，对头孢噻肟、头孢吡肟、头孢他啶耐药率高达79％～100％，明显高于ESBLs阴性组；对哌拉西林／他唑巴坦、头孢哌酮／舒巴坦加酶抑制剂药物耐药率低；对亚胺培南、复方新诺明、左氧氟沙星普遍敏感。结论新生儿肺炎克雷伯菌感染首选药物为哌拉西林／他唑巴坦、头孢哌酮／舒巴坦加酶抑制剂类药物，重症患儿首选碳青霉烯类药物。临床医师应根据药敏试验结果选用抗生素，以减少ESBLs菌株的产生。

89 Cases of Neonatal Klebsiella Pneumoniae Infection and Drug Sensitivity Characteristics

Objective To investigate the clinical features and susceptibility of Klebsiella pneumoniae infection in neonates, as well as extended-spectrum 15-1actamases （ESBLs） incidence so as to guide the clinical rational drug use and take appropriate clinical measures.Methods Retrospec- tive analysis was made on the clinical data of 89 neonatals with pharyngeal swab, sputum, u- rine and blood culture diagnosed with Klebsiella pneumonia bacteria nosocomial infection and bac- terial susceptibility test results.Results Klebsiella pneumoniae infection occurred mostly in respira- tory tract, followed by bloodstream infections and urinary tract infections. Of the cultivated 89 cases of KlebsieUa pneumoniae, 52 （58.4%） produced extended- spectrum 13-lactamases （ ES- BLs）, cefotaxime, cefepime, ceftazidime resistance rates were as high as 79%-100%, which were significantly higher than those in ESBLs negative group; piperacillin / tazobactam, cef- operazone/ Shuba Tanga inhibitor drug resistance was low, and were generally sensitive to imipenem, sulfamethoxazole, levofloxacin.Conclusion The preferred neonatal drug against Kleb- siella pneumoniae infection are piperacillin / tazobactam, cefoperazone / Shuba Tanga inhibitor class of drugs, and carbapenems for children in severe cases. Clinicians should consider sus- ceptibility testing results in selecting antibiotics to reduce the generation of ESBLs strains.