产超广谱β-内酰胺酶肺炎克雷伯菌和大肠埃希菌引起新生儿严重感染的治疗分析

目的:探讨新生儿病房产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌和大肠埃希菌耐药特点,指导临床用药。方法:经痰、血、脑脊液培养确诊为产ESBLs肺炎克雷伯菌及大肠埃希菌引起新生儿感染23例,分析药敏试验结果及治疗情况。结果:产ESBLs菌对亚胺培南普遍敏感,对舒普深耐药率低,肺炎克雷伯菌耐药率为36.36％,大肠埃希菌为25.0％,对头孢他啶、头孢曲松、头孢噻肟及氨曲南耐药率高达75％～100％,且部分体外敏感菌株在体内却表现出临床意义的耐药,对磺胺类、氨基糖甙类、氟喹诺酮类均表现出较高的耐药性。结论:亚胺培南及含β-内酰胺酶抑制剂复合物为新生儿病房产ESBLs菌感染的首选药物。

Treatment of Newborn Infection Caused by Klebsiella Pneumoniae and Escherichia Coli Producing Extended-Spectrum beta-Lactamasas

Objective: To study characteristics of antibiotic resistance of Klebsiella pneumoniae and Escherichia coli producing extended-spectrum beta-lactamases in newborn ward, and help to select antibiotic drugs. Methods: The sputum, blood and cerebrospinal fluid were cultured in 23 cases of infected newborn. The infection was caused by Klebsiella pneumoniae and Escherichea coli producing extend-spectrum beta-lactamases, then, the results of susceptibility test and treatment were analysed. Results : The ESBLs-producing strains are sensitive to imipenem, and low in the artibiotic resistance rate of sulperazon, the antibiotic resistance rate is about 36.36% in Klebsiella pneumoniae and 25.00% in Escherichia coli. However, the antibiotic resistance rate is above 80% - 100% in ceftazed-inie, ceftriaxone, cefotaxime, aztreonam and the partially sensitive strains out of body put up antibiotic resistance inside. The ESBLs-producing strains have high antibiotic resistance to sulfonamides, aminoglycosides, quinolones. Conclusion : Imipenem and β-laclama/β-lactamase inhibitor combinations are the first selected drugs in treating newborn infection caused by producing extended-speclum beta-lactomases strains.