新生儿肺炎克雷伯菌败血症临床特点和药敏分析

目的：探讨新生儿肺炎克雷伯菌败血症的临床特点及药物敏感情况，为早期诊断和合理治疗提供依据。方法：对2000年1月至2009年8月确诊的42例肺炎克雷伯菌败血症新生儿的临床资料及药敏结果进行回顾性分析。结果：新生儿肺炎克雷伯菌败血症临床表现多样,以发热或低体温、呼吸道症状及喂养不耐受多见，95%的病例C反应蛋白（CRP）增高，病死率为21%。早发型新生儿肺炎克雷伯菌败血症对阿莫西林/棒酸、哌拉西林/他唑巴坦、头孢西丁、亚胺培南、头孢哌酮/舒巴坦较敏感，晚发型仅对头孢西丁、哌拉西林/他唑巴坦、亚胺培南敏感，均对青霉素类、头孢菌素类敏感率低。肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）菌株高达92%，其中晚发型败血症ESBLs检出率明显高于早发型（100% vs 70%, P<0.05）。结论：新生儿肺炎克雷伯菌败血症临床表现多无特异性，CRP检测对早期诊断有一定价值。早发型与晚发型败血症对药物的敏感性有差异。［中国当代儿科杂志，2010，12（9）：700-703］

Clinical characteristics of neonatal Klebsiella pneumoniae sepsis and the antibiotic sensitivity pattern of strains

Objective To study the clinical characteristics of neonatal sepsis caused by Klebsiella pneumoniae and the antibiotic sensitivity pattern of Klebsiella pneumoniae strains.Methods The clinical data of 42 cases of neonatal sepsis caused by Klebsiella pneumoniae from January,2000 to August,2009 were retrospectively studied.Results The clinical presentations were non-specific,including fever or hypothermia,tachypnea,apnea and feeding intolerance.C-reactive protein (CRP) level increased in 95% of the cases.The mortality was 21%.In neonates with early onset sepsis,Klebsiella pneumoniae strains were sensitive to amoxicillin/clavulanic-acid,piperacillin/tazobactam,cefoxitin,imipenem,cefoperazone/and sulbactam.In neonates with late onset sepsis,the sensitive antibiotics of Klebsiella pneumoniae strains were less,including cefoxitin,piperacillin/tazobactam and imipenem.Klebsiella pneumoniae strains were not sensitive to penicillins and cephalosporins in either neonates with early onset sepsis or late onset sepsis.The extended spectrum βlactamases (ESBLs)-producing strains were found in 92% of the cases.The neonates with late onset sepsis presented a higher prevalence of ESBLs-producing strains than those with early onset sepsis (100% vs 70% ;P < 0.05).Conclusions The clinical manifestations of neonatal sepsis caused by Klebsiella pneumoniae are usually non-specific.CRP detection is valuable for early diagnosis of sepsis.There are differences in the antibiotic sensitivity of strains between the neonates with early onset and late onset Klebsiella pneumoniae sepsis.