婴幼儿肺泡灌洗液中肺炎克雷伯菌对β- 内酰胺类抗生素的耐药变迁

目的 探讨2015～2018年婴幼儿呼吸道感染肺炎克雷伯菌对β-内酰胺类抗生素的耐药趋势,为临床合理用药、提高患者的治愈率和延缓细菌耐药性的产生提供科学依据。方法 回顾性分析婴幼儿肺泡灌洗液中肺炎克雷伯菌药敏结果以及耐药性。结果 2015-2018年,婴幼儿肺泡灌洗液中肺炎克雷伯菌的检出率分别为23.71%,15.60%,18.80%和23.74%。尽管四年间肺炎克雷伯菌产超广谱β-内酰胺(extended-spectrum β-lactamases,ESBLs)类抗生素检出率差异无统计学意义(χ²=5.83,P>0.05),但两两比较发现2018年产ESBLs的肺炎克雷伯菌检出率显著高于2016年,其差异有统计学意义(χ²=5.66,P<0.05)。四年间的药敏结果显示,肺炎克雷伯菌对头孢曲松、头孢他啶、头孢比肟、氨曲南和亚胺培南的耐药率分别由2015年的52.17%,13.04%,0.00%,8.70%和4.35%升至2018年的74.47%,59.57%,59.57%,40.43%和19.15%,卡方趋势分析结果显示肺炎克雷伯菌对头孢他啶、头孢吡肟、氨苄西林/舒巴坦和氨曲南的耐药率分布差异均有统计学意义(χ²=13.77,23.09,25.39,8.93,P=0.003,<0.001,<0.001,0.030)。结论 近年来婴幼儿呼吸道感染的肺炎克雷伯菌感染率与耐药率均有增长趋势。该文强调了在婴幼儿群体中评估肺泡灌洗液细菌培养和抗生素敏感性实验的重要性,早期实施医学干预可降低肺炎克雷伯菌抗生素耐药性的产生。

Changes of Resistance of Klebsiella Pneumoniae to Beta-Lactam Antibiotics in Alveolar Lavage Fluid of Infants

Objective To explore the long-term changes of beta-lactamase antibiotic resistance of Klebsiella pneumoniae in infants with respiratory tract infection from 2015 to 2018, and provide medical implementations for rational antibiotic use, patient cure rate and delay the bacterial resistance. Methods The antibiotic resistance of Klebsiella pneumoniae in infantile alveolar lavage fluid were analyzed retrospectively. Results During the 4 year period, the detection rates of Klebsiella pneumoniae in infantile alveolar lavage fluid were 23.71%, 15.60%, 18.80% and 23.74%, respectively. There was no statistical significant difference in ESBLs production between the four year period(χ²=5.83,P>0.05). However, the comparison between the two groups found that the ESBLs rate of Klebsiella pneumoniae increased from 22.7% in 2016 to 53.2% in 2018, and the difference was statistical significant(χ²=5.66,P<0.05). The antibiotic sensitivity test results during the four years showed that the rate of Klebsiella pneumoniae resistant to ceftriaxone, ceftazidine, cefepime, aztrexam and imiperam rose from 52.17%, 13.04%, 0.00%, 8.70% and 4.35% in 2015 to 74.47%, 59.57%, 59.57%, 40.43% and 19.15%, respectively in 2018. Chi-square trend analysis showed that the distribution of resistance rates to ceftazidime, cefepime, ampicillin/sulbactam and aztreonam was statistical significant(χ²=13.77,23.09,25.39,8.93,P=0.003, <0.001, <0.001,0.030, respectively). Conclusion There is a long-term growth trend in Klebsiella pneumoniae infection rate and antibiotic resistance during these years. The study highlights the urgent needs to evaluate the possibility of alveolar lavage fluid bacterial culture and antibiotic sensitivity test and much emphasis must be laid on the early implementation of medical intervention to reduce the antibiotic resistance rate of Klebsiella pneumoniae identified from pediatrics.