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目的:总结我院新生儿重症监护室肺炎克雷伯菌属感染患儿的临床特征及肺炎克雷伯菌属的耐药性,为临床早期诊断和合理用药提供依据。方法:回顾性分析62例肺炎克雷伯菌属培养阳性患儿的临床资料,包括胎龄、分娩方式、年龄、出生体质量、住院时间、基础疾病、血常规、C-反应蛋白、药敏试验结果、转归等。结果:62例患儿中,早产儿37例(59.68%),足月儿23例(37.10%),过期产儿2例(3.23%)。24例痰培养或气管插管导管末端培养1次阳性,11例胃液培养1次阳性,12例2次以上不同部位(痰、胃液、气管插管末端、尿液及分泌物)培养阳性。其中55例有基础疾病,包括呼吸窘迫综合征29例,肺部感染13例,窒息及并发症8例,败血症3例,坏死性小肠结肠炎2例。平均住院时间24.3 d。62例患儿中,治愈54例(87.10%),好转5例(8.06%),放弃治疗2例(3.23%),死亡1例(1.61%)。肺炎克雷伯菌对氨苄西林100%耐药,分离出耐碳青霉烯类肺炎克雷伯杆菌。结论:新生儿科重症监护室肺炎克雷伯菌属感染的发生受多种因素的影响,临床应根据药敏试验结果合理使用抗菌药物,同时采取综合防治措施控制感染。
Objective: To summarize the clinical features of Klebsiella pneumoniae in our hospital neonatal intensive care unit and the antibiotic resistance of Klebsiella pneumoniae, so as to provide the basis for early clinical diagnosis and reasonable medication. Methods: The clinical data of 62 cases of Klebsiella pneumoniae positive children were retrospectively analyzed, including gestational age, mode of delivery, age, birth weight, length of hospital stay, underlying diseases, blood tests, C-reactive protein, Test results, outcome and so on. Results: Among the 62 children, 37 (59.68%) were premature infants, 23 (37.10%) full-term infants and 2 (3.23%) infants. Twenty-four cases of sputum culture or endotracheal intubation were positive for one culture, 11 cases for gastric juice were positive for one time, and 12 cases for more than two times were positive for sputum, gastric juice, endotracheal intubation, urine and secretions. Among them, 55 cases had underlying diseases, including 29 cases of respiratory distress syndrome, 13 cases of pulmonary infection, 8 cases of asphyxia and complications, 3 cases of sepsis and 2 cases of necrotizing enterocolitis. The average hospital stay was 24.3 days. Of the 62 children, 54 (87.10%) were cured, 5 (8.06%) were improved, 2 (3.23%) were given up, and 1 died (1.61%). Klebsiella pneumoniae 100% resistant to ampicillin, resistant to carbapenem-resistant Klebsiella pneumoniae. Conclusions: The occurrence of Klebsiella pneumoniae infection in neonatal intensive care unit is affected by many factors. In clinical practice, antibiotics should be used reasonably according to the results of drug susceptibility test. At the same time, comprehensive prevention and control measures should be taken to control the infection.