新生儿病房肺炎克雷伯菌感染现状分析

目的:调查我院新生儿病房及其重症监护室(NICU)肺炎克雷伯菌的感染和耐药情况,分析其感染原因,并制订预防措施.方法:对我院2004年1月～2007年4月,新生儿病房及NICU肺炎克雷伯菌感染情况进行回顾性分析总结.结果:肺炎克雷伯菌感染在新生儿病房感染性疾病中占很高的比例,早产儿、低体质量儿,器械通气治疗为新生儿感染的易患因素.肺炎克雷伯菌感染的部位常见为呼吸道共50例,占呼吸道细菌感染的53%,其次为血液共57例,占败血症的41%.109例患儿共分离出114株肺炎克雷伯菌,其中94株为产超广谱β-内酰胺酶的ESBLs菌株.肺炎克雷伯菌对亚胺培南的敏感率达100%,对哌拉西林/他唑巴坦的敏感率达92.2%,对庆大霉素、阿米卡星、环丙沙星的敏感率为74.6%～100%,对常用的青霉素、头孢菌素均不敏感.结论:肺炎克雷伯菌特别是ESBLs菌株,已成为新生儿病房感染的主要病原菌,其比例增高应引起高度重视.严格执行新生儿病房的消毒隔离制度可减少患儿感染机会,严格掌握三代头孢菌素的应用指征,严加限制预防性用药,可降低ESBLs菌株的产生.碳青霉烯类如亚胺培南是肺炎克雷伯菌的首选用药.

Analysis of Klebsiella pneumoniae infection in neonates

Objective: To investigate current status and causes of K.pneumoniae infection in neonates and Neonatal Intensive Care Unit(NICU) of our hospital,and to suggest appropriate countermeasures.Methods: K.pneumoniae infection cases in newborn infants and NICU of our hospital from January 2004 to April 2007 were retrospectively analyzed. Results: K.pneumoniae was the most common in newborn infants infection,factors in the causation of disease were premature birth,underweight,or using breathing apparatus.Fifty neonates infected K.pneumoniae in the respiratory tract,53% of bacterium infection in the respiratory tract.57 neonates infected K.pneumoniae in blood,41% of septicemia.All of 114 strains of K.pneumoniae were isolated from 109 septic neonates,of which 94 strains were ESBLs.All the K.pneumoniae strains were sensitive to imipenem,the sensitive rate of K.pneumoniae to piperacillin/tazobactam,gentamicin,amikacin and cyprofloxacin was 74.6%~100%,but resistant to penicillin and cephalosporins. Conclusion: K.pneumoniae especially ESBLs were the major pathogens causing neonatal infection with increasing tendency,it should be paid great attention.Sterilization and isolation measures in neonates were important in that they can reduce the chance of K.pneumoniae infection.To control the use of third generation cephalothin and the preventive drug can reduce the number of ESBLs.Carbapenems such as imipenem were the first choice to K.pneumoniae infection.