产NDM-1型碳青霉烯酶肺炎克雷伯菌儿童血流感染的临床特征及细菌耐药性分析

发布时间：2018-05-04 10:55

本文选题：新德里金属β内酰胺酶- + 肺炎克雷伯菌　；参考：《中国感染与化疗杂志》2017年05期

【摘要】：目的研究产NDM-1型碳青霉烯酶肺炎克雷伯菌儿童血流感染的临床特征及细菌耐药性。方法收集首都医科大学附属北京儿童医院2011年1月-2014年8月住院患儿血培养分离的非重复耐碳青霉烯类肺炎克雷伯菌(CRKp);用微量肉汤稀释法测定15种抗菌药物的MIC值;采用PCR法确定产NDM-1菌株;回顾分析病历资料了解感染产NDM-1菌株患儿的临床特征,并与感染非产NDM-1菌株患儿进行比较。结果 52株CRKp中共检出28株产NDM-1菌株。产NDM-1菌株组均为多重耐药菌,对青霉素、头孢菌素和哌拉西林-他唑巴坦的耐药率达100%(28/28),对氨曲南、甲氧苄啶-磺胺甲唑及庆大霉素的耐药率均75%,对亚胺培南和美罗培南的耐药率分别为100%(28/28)、92.9%(26/28)。产NDM-1菌株中碳青霉烯类高MIC值的菌株比例高于非产NDM-1菌株。产NDM-1菌株组的患儿中,82.1%(23/28)来自血液病房,常见基础疾病为血液系统恶性肿瘤(78.6%,22/28),20例(76.4%)患儿存在中性粒细胞缺乏伴发热;产与非产NDM-1肺炎克雷伯菌血流感染患儿相比,反复住院(P=0.202)、近期使用抗菌药物(P=0.615)、常见基础疾病(P=0.856)以及深静脉置管(P=0.099)方面差异无统计学意义。明确肺炎克雷伯菌感染后,37例患儿接受了碳青霉烯类药物联合敏感药物治疗。产NDM-1菌株组病死率与非产NDM-1菌株组相比无明显差异(2/28对3/24;P=0.625)。结论该院已出现产NDM-1肺炎克雷伯菌株,呈逐年增长趋势,此类细菌呈多重耐药,碳青霉烯类高MIC值的菌株所占比例高,临床特征上与非产NDM-1菌无明显区别。
[Abstract]:Objective to study the clinical characteristics and bacterial resistance of NDM-1-producing Klebsiella pneumoniae in children. Methods the blood culture of non-repeated penicillin-resistant Klebsiella pneumoniae from January 2011 to August 2014 in Beijing Children's Hospital affiliated to Capital Medical University was collected, and the MIC values of 15 antimicrobial agents were measured by broth dilution method. PCR method was used to determine the NDM-1 producing strains, and the clinical characteristics of children infected with NDM-1 were analyzed retrospectively, and compared with those of children infected with non- strains. Results A total of 28 NDM-1 producing strains were detected in 52 CRKp strains. All the strains producing NDM-1 were multidrug resistant. The resistance rate to penicillin, cephalosporin and piperacillin tazobactam was 100% 28 / 28, and to aztreonam. The resistance rates of trimethoprim-sulfamethazol and gentamicin were 75 and 100% 28 / 28 / 92. 9% for imipenem and meropenem respectively. The proportion of NDM-1 producing strains with higher MIC value of carbapenes was higher than that of non- producing strains. In the NDM-1 producing group, 23 / 28% of the children were from the blood ward. The common underlying diseases were malignant tumor of the blood system, 78.6% / 28% (20 cases) with neutrophil deficiency and fever, compared with the children with non-producing Klebsiella pneumoniae blood stream infection. There was no significant difference in P0. 202, P0. 615, P0. 856 and P0. 099). 37 children with Klebsiella pneumoniae infection were treated with carbapenem combined with sensitive drugs. There was no significant difference in mortality between NDM-1 producing strain group and non NDM-1 producing strain group. There was no significant difference between 2 / 28 and 3 / 24 p0. 625% NDM-1 producing strains. Conclusion Klebsiella pneumoniae has been found in our hospital, which is increasing year by year. The bacteria are multidrug resistant and the proportion of strains with high MIC value of carbapenem is high. There is no significant difference between the clinical characteristics and non-NDM-1 producing bacteria.
【作者单位】：首都医科大学附属北京儿童医院感染内科;首都医科大学附属北京儿童医院细菌室;
【分类号】：R446.5;R725.1

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