Abstract:

Objective　To investigate the clinical distribution characteristics and the resistance of Klebsiella pneumoniae  isolates during the period from Jan. 2011 to Dec. 2015 in Children’s Hospital Affiliated to Shanghai Jiao Tong University and to provide references for clinical control and therapy of infection. Methods　A total of 1566 Klebsiella pneumoniae strains were collected in our hospital from 2011 to 2015. The bacteria were identified by vitek 2 compact instrument and antibiotic susceptibility was determined by K-B disk diffusion method. The data were analyzed by SPSS 19.0. Results　A total of 1566 Klebsiella pneumoniae strains were isolated from Jan. 2011 to Dec. 2015. In five years，the Klebsiella pneumoniae-positive specimens were mostly derived from sputum（60.22%-73.63%），urine（7.53%-12.81%） and blood（3.66%-5.45%）；the rate of the ESBL-producing strains of Klebsiella pneumoniae  was 69.18%-76.02%（P＞0.05）；the rate of  carbapenem-resistant  Klebsiella pneumoniae isolated was 5.82%-31.50%（P＜0.01）；both the bacteria of the ESBL-producing strains and  carbapenem-resistant  Klebsiella pneumoniae were mainly  distributed in neonate ward units and secondly comprehensive ward and intensive care unit. The drug resistance of the ESBL-producing strains of Klebsiella pneumoniae were significantly higher than the non- ESBL-producing strains（P＜0.05）. The resistance rate of carbapenem-resistant  Klebsiella pneumoniae has been high，and gradually increased from 2011 to 2015（P＜0.05）. The isolated strains were resistant to all antimicrobial drugs except trimethoprim- sulfanilamide and amikacin. The 5-year resistance rate statistics were significantly increased（P＜0.05）. Conclusion　Drug resistance of Klebsiella pneumoniae in pediatrics is becoming more and more serious. Multidrug resistant strains are becoming more and more common in Neonatal ward and ICU. The pressure of antibiotics used in the treatment of Klebsiella pneumoniae is increasing in clinical. The infection should be controlled effectively and the resistant strains should be reduced.

Key words: Klebsiella pneumoniae, drug resistance, monitoring, antibiotics, carbapenems

摘要：

目的　了解上海交通大学附属儿童医院2011年1月至2015年12月期间临床分离肺炎克雷伯菌的分布特征和耐药情况，为临床提供预防和控制感染的依据。方法　收集2011—2015年上海交通大学附属儿童医院临床分离的1566株肺炎克雷伯菌，M-H培养基进行细菌培养，采用K-B纸片扩散法进行药敏试验，运用SPSS19.0统计软件进行统计分析。结果　2011年1月至2015年12月共检出肺炎克雷伯菌1566株，5年内肺炎克雷伯菌的标本主要来源于痰（60.22%～73.63%）、尿（7.53%～12.81%）、血（3.66%～5.45%）；肺炎克雷伯菌产超广谱β内酰胺酶（ESBLs）的检出阳性率（69.18%～76.02%）（P＞0.05）及耐碳青霉烯类肠杆菌（CRE）菌株的检出阳性率（5.82%～31.50%）（P＜0.01）；ESBLs菌株和CRE菌株的临床分布以新生儿病区最高，其次为综合内科、重症监护病区；产ESBLs菌株对大多数抗菌药物的耐药率显著高于非产ESBLs菌株（P＜0.05）；耐碳青霉烯类药物的肺炎克雷伯菌对大部分的抗菌药物呈较高的耐药率，且耐药率呈逐年上升的趋势，仅对氨基糖肽类、 磺胺类耐药率较低，5年的耐药率统计有显著提高（P＜0.05）。结论　儿科患者正面临肺炎克雷伯菌感染情况日趋严重的困境，菌株越来越具有多重耐药的特点，尤以新生儿病区、重症监护病区突出；临床上治疗肺炎克雷伯菌感染选用抗生素的压力也随之日趋严峻，应合理有效地控制感染，并减少耐药菌株的产生。

关键词: 肺炎克雷伯菌, 耐药性, 监测, 抗菌药物, 碳青霉烯类