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目的了解儿童下呼吸道感染肺炎克雷伯菌的耐药性及其DHA基因型情况,为临床诊疗提供依据。方法对湖南省儿童医院2010年1月-2012年1月下呼吸道感染住院患儿,常规进行深部痰培养,用全自动微生物分析仪VITEK2compact进行鉴定和药敏试验,并进行DHA基因检测。结果 31 568份合格下呼吸道感染患儿痰标本,共分离出1 864株肺炎克雷伯菌,检出率6.0%。其中的23株肺炎克雷伯菌对氨苄西林、头孢一二三代(包括含酶抑制剂的抗菌药物)、氨曲南等耐药率较高,对头孢吡肟、亚胺培南、环丙沙星敏感率较高。基因检测显示:肺炎克雷伯菌有DHA型AmpC酶。结论肺炎克雷伯菌是儿童下呼吸道感染的重要病原菌。其中对于产DHA酶菌株头孢吡肟是首选药物,重症患儿可用亚胺培南。加强抗菌药物使用的控制,防止更多的耐药基因在菌种中传播。
Objective To understand the drug resistance and DHA genotype of children with lower respiratory tract infection of Klebsiella pneumoniae and provide basis for clinical diagnosis and treatment. Methods Inpatients with lower respiratory tract infection in Children’s Hospital of Hunan Province from January 2010 to January 2012 were enrolled in this study. Sputum culture was routinely performed in deep sputum. VITEK2compact was used for identification and drug susceptibility testing. DHA gene was also detected. Results A total of 1 564 strains of Klebsiella pneumoniae were isolated from 31 568 sputum samples of children with lower respiratory tract infection, the detection rate was 6.0%. Among them, 23 strains of Klebsiella pneumoniae were highly resistant to ampicillin, cephalosporins one and two generations (including antibiotics with enzyme inhibitor) and aztreonam. The resistance rate to cefepime, imipenem, Ciprofloxacin is more sensitive. Genetic testing showed that: Klebsiella pneumoniae has DHA type AmpC enzyme. Conclusion Klebsiella pneumoniae is an important pathogen of lower respiratory tract infection in children. Which for the production of DHA enzyme cefepime is the drug of choice, severe infants with imipenem. Strengthen the control of the use of antimicrobial agents to prevent more resistant genes from spreading in the strains.