儿童肺炎克雷伯菌血流感染临床特征及菌株药物敏感性分析

摘要：目的 探讨儿童肺炎克雷伯菌血流感染(Klebsiella pneumoniae bloodstream infection, KPBSI)临床特征及肺炎克雷伯 菌(Klebsiella pneumoniae, KP)对常用抗菌药物的敏感性，为儿童KPBSI合理治疗提供参考。方法 回顾性分析2014年1月至2019 年12月在重庆医科大学附属儿童医院住院的KPBSI患儿临床资料。结果 共纳入110例患儿，64例(58.2%)为院内感染，72例 (65.5%)有基础疾病，以血液系统肿瘤最多见。110例患儿PRISM Ⅲ评分为16.0(7.0~20.8)，其中74例(67.3%)发生脓毒症，15例 (13.6%)发生脓毒性休克，18例(16.4%)发生呼吸衰竭，15例(13.6%)需有创机械通气，院内死亡共13例(11.8%)。KP菌株对阿米卡 星、碳青霉烯类抗菌药物敏感率＞90%，对头孢噻肟、头孢曲松和头孢他啶的敏感率分别为58.3%、60.9%和70.9%，对头孢哌 酮/舒巴坦和哌拉西林/他唑巴坦的敏感率分别为59.5%和82.7%。检出ESBLs+菌株39株(39/86，45.3%)，耐碳青霉烯类肺炎克雷 伯菌(CRKP)菌株10株(10/110，9.1%)，ESBLs+KP菌株和CRKP在各年龄组间分布无统计学差异。结论 儿童KPBSI多见于有基 础疾病的患儿，脓毒症、脓毒性休克和呼吸衰竭发生率高；KP菌株对头孢他啶和哌拉西林/他唑巴坦敏感性较高，可经验性治 疗轻症KPBSI患儿。

Analysis of clinical characteristics and antimicrobial susceptibility in children with Klebsiella pneumoniae bloodstream infection

Abstract Objective To investigate the clinical characteristics and bacterial antimicrobial susceptibility in children with Klebsiella pneumoniae bloodstream infection (KPBSI) so as to guide the use of antibiotics. Methods The clinical data of children with KPBSI who hospitalized in Children's Hospital of Chongqing Medical University from January 2014 to December 2019 were analyzed retrospectively. Results A total of 110 cases were enrolled, with 64 cases (58.2%) were hospital-acquired infections. 72 cases (65.5%) had underlying diseases, and the most common washematologic malignancy. The overall PRISM Ⅲ score was 16.0 (7.0~20.8), 74 cases (67.3%) developed to sepsis, 15 cases (13.6%) developed to septic shock, 18 cases (16.4%) developed to respiratory failure and 15 cases (13.6%) needed invasive mechanical ventilation. The mortality was 11.8% (13/110). The susceptibility to amikacin and carbapenems was over 90%. The susceptibility to cefotaxime, ceftriaxone and ceftazidime was 58.3%, 60.9% and 70.9%, while the susceptibility to cefperazone-sulbactam and piperacillin-tazobactam was 59.5% and 82.7%, respectively. The detection rates of ESBLs producing and carbapenem-resistant Klebsiella pneumoniae were 45.3% (39/86) and 9.1% (10/110) respectively, and no significant differences were found in different age groups. Conclusions Children with KPBSI usually have underlying diseases, with high incidence of sepsis, septic shock and respiratory failure. Ceftazidime and piperacillin-tazobactam may provide options for the empirical treatment of mild KPBSI in