婴幼儿社区获得性肺炎克雷伯菌肺炎的临床特点及耐药分析

目的：探讨婴幼儿社区获得性肺炎克雷伯菌肺炎的临床特点及耐药特征。方法：收集2007～2011年65例婴幼儿社区获得性肺炎克雷伯菌肺炎住院病例，对其临床资料进行回顾性分析。结果：65例患儿中，≤3个月小婴儿37例（57%），4个月~ 17例（26%），7个月~ 7例（11%），13~24个月4例(6%)。患儿临床表现及X线胸片特点与其他细菌性肺炎无明显差异。产超广谱β内酰胺酶（ESBLs）肺炎克雷伯菌检出40株，检出率为62%。肺炎克雷伯菌对亚胺培南、美罗培南、阿米卡星敏感率为100%，但对青霉素、头孢菌素普遍耐药；产ESBLs菌株对青霉素类、头孢菌素类、阿莫西林/棒酸、氨苄西林/舒巴坦、复方新诺明、庆大霉素、环丙沙星及氨曲南的耐药率显著高于非产ESBLs菌株，呈多重耐药性。结论：社区获得性肺炎克雷伯菌肺炎常见于3个月内的小婴儿。产ESBLs菌株在肺炎克雷伯菌社区获得性肺炎感染中非常流行,其耐药率高，且呈多重耐药性。

Clinical features and antimicrobial resistance of community-acquired pneumonia caused by Klebsiella pneumoniae in infants

Objective To study the clinical features and antimicrobial resistance of community-acquired pneumonia caused by Klebsiella pneumoniae in infants.Methods The clinical data of 65 infants with community-acquired pneumonia caused by Klebsiella pneumoniae between 2007 and 2011 were retrospectively studied.Results Of the 65 infants,37 cases(57%) were aged ≤3 months,17 cases(26%) over 4 months,7 cases(11%) over 7 months and 4 cases(6%) between 13 and 24 months.There were no significant differences in clinical manifestations and chest X-ray features between the infants with community-acquired pneumonia caused by Klebsiella pneumoniae and those with other bacterial pneumonia.Forty strains(62%) of ESBLs-producing Klebsiella pneumoniae were detected.Klebsiella pneumoniae was 100% sensitive to imipenem,meropenem and amikacin but resistant to penicillins and cephalosporins.The resistance rates of ESBLs-producing strains to penicillins,cephalosporins,amoxicillin/clavulanic acid,ampicillin/sulbactam,compound sulfamethoxazole,gentamycin,ciprofloxacin and aztreonam were significantly higher than for non-ESBLs-producing strains.ESBLs-producing strains also showed multiple-drug resistance.Conclusions Community-acquired pneumonia caused by Klebsiella pneumoniae is common in infants aged ≤3 months.ESBLs-producing strains are prevalent in community-acquired pneumonia caused by Klebsiella pneumoniae and demonstrate both high rates of drug resistance and multiple-drug resistance.