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目的分析新生儿重症监护病房(NICU)肺炎克雷伯菌医院感染的发生率、临床特点、易感因素、细菌耐药情况及治疗效果。方法对我院2002年1月至2006年12月NICU肺炎克雷伯菌医院感染62例患儿作回顾性分析。结果肺炎克雷伯菌医院感染发生率为2.05%(62/3024),早产儿占80.64%,平均发病时间为住院(13.7±5.2)d。发病高危因素为早产低体重、使用广谱抗生素、静脉营养及住院时间长。常见临床表现为拒奶、发热、呼吸窘迫、腹胀、黄疸、休克、出血倾向。预后不良率为40.32%(死亡17例,放弃8例)。细菌药敏结果显示,该菌对青霉素类、头孢菌素类抗生素耐药率高达78.6%～100%,明显高于对碳青霉烯、喹诺酮类抗生素的耐药率(P<0.001)。结论肺炎克雷伯菌是NICU医院感染的重要致病菌,一旦发病,病情凶险、病死率高;治疗应根据药敏试验结果选择抗生素。
Objective To analyze the incidence, clinical characteristics, susceptibility factors, bacterial resistance and therapeutic effect of Klebsiella pneumoniae in neonatal intensive care unit (NICU). Methods A retrospective analysis was performed on 62 cases of NIH Klebsiella pneumoniae hospital infection from January 2002 to December 2006 in our hospital. Results The incidence of nosocomial infection in Klebsiella pneumoniae was 2.05% (62/3024), 80.64% in preterm infants and 13.7 ± 5.2 days in hospital. Risk factors for the incidence of preterm low birth weight, the use of broad-spectrum antibiotics, intravenous nutrition and hospitalization for a long time. Common clinical manifestations of rejection of milk, fever, respiratory distress, abdominal distension, jaundice, shock, bleeding tendency. The poor prognosis rate was 40.32% (17 deaths, giving up 8 cases). The results of bacterial susceptibility showed that the resistance rate of the strain to penicillins and cephalosporins was as high as 78.6% -100%, significantly higher than that of carbapenem and quinolone antibiotics (P <0.001). Conclusions Klebsiella pneumoniae is an important pathogen of NICU hospital infection. Once the disease develops, the disease is dangerous and the case fatality rate is high. Antibiotics should be selected according to the susceptibility test results.