[1]邓文喻,陈国洋,麦荣嘉,等.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[J].现代检验医学杂志,2020,35(01):75-78.[doi:10.3969/j.issn.1671-7414.2020.01.020]
　Deng Wen-yu,Chen Guo-yang,Mai Rong-jia,et al.Changes of Resistance of Klebsiella Pneumoniae to Beta-Lactam Antibiotics in Alveolar Lavage Fluid of Infants[J].Journal of Modern Laboratory Medicine,2020,35(01):75-78.[doi:10.3969/j.issn.1671-7414.2020.01.020]
点击复制

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 ()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第35卷
期数:
2020年01期
页码:
75-78
栏目:
论　　著
出版日期:
2020-02-29

文章信息/Info

Title:
Changes of Resistance of Klebsiella Pneumoniae to Beta-Lactam Antibiotics in Alveolar Lavage Fluid of Infants
文章编号:
1671-7414(2020)01-075-04
作者:
邓文喻; 陈国洋; 麦荣嘉; 穆小萍
(广东省妇幼保健院检验医学科,广州 510010)
Author(s):
Deng Wen-yu;  Chen Guo-yang;  Mai Rong-jia;  Mu Xiao-ping
(Department of Laboratory Medicine, Guangdong Women and Children Hospital, Guangzhou 510010,China)
关键词:
肺炎克雷伯菌;  β-内酰胺类抗生素;  产超广谱β-内酰胺酶;  婴幼儿
分类号:
R378,996; R446,5
DOI:
10.3969/j.issn.1671-7414.2020.01.020
文献标志码:
A
摘要:
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。
Abstract:
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.

参考文献/References:

[1] BRADY M, CUNNEY R, MURCHAN S,et al. Klebsiella pneumonia bloodstream infection, antimicrobial resistance and consumption trends in Ireland: 2008 to 2013[J]. Eur J Clin Microbiol Infect Dis,2016,35(1):1777-1785.
[2] 游楚明,陈历耋,谢燕丕,等.早产儿肺炎克雷伯菌感染临床分析[J].中国妇幼健康研究,2017,28(10):1299-1301. You Chuming,CHEN Lidie,XIE Yanpi,et al. Clinical analysis on Klebsiella pneumoniae infection in preterm infants[J]. Chinese Journal of Woman and Child Health Research,2017,28(10):1299-1301.
[3] 凌勇,肖洪广,邱芳华.耐碳青霉烯肺炎克雷伯菌的耐药基因分析[J]. 热带医学杂志,2018,18(3):358-361. LING Yong,XIAO Hongguang,QIU Fanghua. Analysis of drug resistance genes in carbapenem-resistant Klebsiella pneumoniae[J]. Journal of Tropical Medicine,2018,18(3):358-361.
[4] 杨家武,付红敏,余凯,等.495例肺炎患儿支气管肺泡灌洗液与痰液细菌培养对比研究[J].中国现代医生,2018,56(28):112-114. Yang Jiawu,FU Hongmin,YU Kai,et al. Comparative study on bacterial culture of bronchoalveolar lavage fluid and sputum in 495 children patients with pneumonia[J].China Modern Doctor,2018,56(28):112-114.
[5] 袁胜红.儿科应用氨基糖苷类抗生素的不良反应分析[J].中国实用医药,2015,10(3):170-171. Yuan Shenghong. Analysis of adverse reactions in pediatric application of aminoglycoside antibiotics[J]. China Practical Medicine,2015,10(3):170-171.
[6] 徐晓涵.氟喹诺酮类药物存在致残和永久严重不良反应风险[J].中国食品药品监管, 2017, 3:77. XU Xiaohan. Risk of disability and permanent serious adverse reactions of Fluoroquinolone[J]. China Food Drug Administration,2017,3:77.
[7] 程莉,谭婷婷,魏红霞,等.临床分离的耐碳青霉烯肺炎克雷伯菌的耐药机制研究[J].现代检验医学杂志,2017,32(3):112-114. CHENG Li,TAN Tingting,WEI Hongxia,et al. Resistance mechanisms of clinical isolated carbapenem-resistant Klebsiella pneumoniae[J]. Journal of Modern Laboratory Medicine,2017,32(3):112-114.
[8] CORCIONE S,ANGILLETTA R,RAVIOLO S,et al. Epidemiology and risk factors for mortality in bloodstream infection by CP-Kp, ESBL-E, Candida and CDI: A single center retrospective study[J]. Eur J Intern Med,2018,48(2):44-49
[9] 胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251. HU Fupin,GUO Yan,ZHU Demei,et al. Antimicrobial resistance profile of clinical isolates in hospitals across China:report from the CHINET Surveillance Program, 2017[J]. Chinese Journal of Infection and Chemotherapy,2018,18(3):241-251.
[10] 李瑞蓉,崔雪萍.肺炎克雷伯菌主要耐药机制研究进展[J].中华临床实验室管理电子杂志,2016,4(2):86-90. LI Ruirong,CUI Xueping. Research advance of drug resistance mechanism of Klebsiella pneumonia[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition),2016,4(02):86-90.
[11] DEVRIM F,SERDAROGˇLU E,CAGˇLARI·,et al. The emerging resistance in nosocomial urinary tract infections: from the pediatrics perspective[J]. Mediterr J Hematol Infect Dis,2018,10(1):e2018055.

相似文献/References:

[1]程 莉,谭婷婷,魏红霞,等.临床分离的耐碳青霉烯肺炎克雷伯菌的耐药机制研究[J].现代检验医学杂志,2017,32(03):112.[doi:10.3969/j.issn.1671-7414.2017.03.030]
　CHENG Li,TAN Ting-ting,WEI Hong-xia,et al.Resistance Mechanisms of Clinical Isolated Carbapenem-Resistant Klebsiella Pneumoniae[J].Journal of Modern Laboratory Medicine,2017,32(01):112.[doi:10.3969/j.issn.1671-7414.2017.03.030]
[2]马　娟,王　翠,苍金荣,等.2016~2020年陕西省临床肺炎克雷伯菌分布及耐药性变迁[J].现代检验医学杂志,2021,36(06):132.[doi:10.3969/j.issn.1671-7414.2021.06.028]
　MA Juan,WANG Cui,CANG Jin-rong,et al.Distribution and Drug Resistance Tendency of Klebsiella Pneumoniae in Shaanxi Province from 2016 to 2020[J].Journal of Modern Laboratory Medicine,2021,36(01):132.[doi:10.3969/j.issn.1671-7414.2021.06.028]

备注/Memo

备注/Memo:
基金项目:广东省中医药局科研项目(20161029)。 作者简介:邓文喻(1977-),女,硕士学位,副主任检验技师,主要从事细菌耐药方面的研究,E-mail:48684355@qq.com。收稿日期:2019-05-27 修回日期:2019-08-01
更新日期/Last Update: 2020-03-30