临床儿科杂志
臨床兒科雜誌
림상인과잡지
2014年
3期
228-231
,共4页
大肠埃希菌%肺炎%超广谱β内酰胺酶%耐药性%婴儿
大腸埃希菌%肺炎%超廣譜β內酰胺酶%耐藥性%嬰兒
대장애희균%폐염%초엄보β내선알매%내약성%영인
Escherichia coli%pneumonia%extended spectrumβ-lactamases%drug resistance%infant
目的：了解婴儿大肠埃希菌肺炎的临床特征、超广谱β内酰胺酶（ESBLs）检出率及大肠埃希菌耐药性。方法将2003年6月-2013年6月336例婴儿大肠埃希菌肺炎分为社区感染组和院内感染组，分析临床资料，统计ESBLs检出率和药敏试验结果。结果患儿发病年龄以1~6个月为主，临床特征与其他革兰阴性杆菌肺炎相似。分离的336株大肠埃希菌中196株（58.33%）产ESBLs，院内感染组ESBLs阳性率为84.00%，高于社区感染组的50.96%，差异有统计学意义（χ2=26.17，P<0.05）。2003年6月-2008年5月与2008年6月-2013年6月两个时间段比较，社区感染组的ESBLs阳性率为49.21%和52.59%，差异无统计学意义（χ2=0.30，P>0.05）；而院内感染组从76.74%升高至93.75%，差异有统计学意义（χ2=3.95，P<0.05）。药敏试验结果显示，最敏感的抗生素为碳青霉烯类。结论大肠埃希菌肺炎好发于小婴儿，病情重且容易迁延，院内感染是获得ESBLs的高危因素。社区感染及院内感染抗生素的应用应该有所区别。
目的：瞭解嬰兒大腸埃希菌肺炎的臨床特徵、超廣譜β內酰胺酶（ESBLs）檢齣率及大腸埃希菌耐藥性。方法將2003年6月-2013年6月336例嬰兒大腸埃希菌肺炎分為社區感染組和院內感染組，分析臨床資料，統計ESBLs檢齣率和藥敏試驗結果。結果患兒髮病年齡以1~6箇月為主，臨床特徵與其他革蘭陰性桿菌肺炎相似。分離的336株大腸埃希菌中196株（58.33%）產ESBLs，院內感染組ESBLs暘性率為84.00%，高于社區感染組的50.96%，差異有統計學意義（χ2=26.17，P<0.05）。2003年6月-2008年5月與2008年6月-2013年6月兩箇時間段比較，社區感染組的ESBLs暘性率為49.21%和52.59%，差異無統計學意義（χ2=0.30，P>0.05）；而院內感染組從76.74%升高至93.75%，差異有統計學意義（χ2=3.95，P<0.05）。藥敏試驗結果顯示，最敏感的抗生素為碳青黴烯類。結論大腸埃希菌肺炎好髮于小嬰兒，病情重且容易遷延，院內感染是穫得ESBLs的高危因素。社區感染及院內感染抗生素的應用應該有所區彆。
목적：료해영인대장애희균폐염적림상특정、초엄보β내선알매（ESBLs）검출솔급대장애희균내약성。방법장2003년6월-2013년6월336례영인대장애희균폐염분위사구감염조화원내감염조，분석림상자료，통계ESBLs검출솔화약민시험결과。결과환인발병년령이1~6개월위주，림상특정여기타혁란음성간균폐염상사。분리적336주대장애희균중196주（58.33%）산ESBLs，원내감염조ESBLs양성솔위84.00%，고우사구감염조적50.96%，차이유통계학의의（χ2=26.17，P<0.05）。2003년6월-2008년5월여2008년6월-2013년6월량개시간단비교，사구감염조적ESBLs양성솔위49.21%화52.59%，차이무통계학의의（χ2=0.30，P>0.05）；이원내감염조종76.74%승고지93.75%，차이유통계학의의（χ2=3.95，P<0.05）。약민시험결과현시，최민감적항생소위탄청매희류。결론대장애희균폐염호발우소영인，병정중차용역천연，원내감염시획득ESBLs적고위인소。사구감염급원내감염항생소적응용응해유소구별。
Objective To investigate the clinical features of Escherichia coli pneumonia, the positive rate of extend-spectrumβ-lactamase (ESBLs) produced by Escherichia coli and antimicrobial resistance of Escherichia coli. Methods Three hundred and thirty-six infants with Escherichia coli pneumonia were divided into community acquired infection group and hos-pital acquired infection group from Jun 2003 to Jun 2013. The clinical data of those patients were collected and analyzed. The ESBLs were examined, and drug susceptibility results were analyzed. Results Infants under 6 months had higher infective rate of Escherichia coli. The Escherichia coli pneumonia had similar clinical manifestations as Gram negative bacterial pneumonia. ESBLs were found in most strains (58.3%, 196/336), positive rate of ESBLs of hospital acquired infection group (84.00%) was higher than that of community acquired infection group (50.96%) (χ2=26.17, P<0.05). There was no difference of ESBLs posi-tive rate between the community acquired infection groups during Jun 2003-May 2008 and those during Jun 2008-Jun 2013 (χ2=0.30, P>0.05). The ESBLs positive rate of hospital acquired infection group was significantly increased from 76.74%(Jun 2003-May 2008) to 93.75% (Jun 2008-Jun 2013) (χ2=3.95, P<0.05). The most sensitive antibiotic was carbapenem. Conclusions Escherichia coli pneumonia mainly occurs in infants, usually with severe clinical situations and more persistent. The hospital acquired infection is the high risk factor of acquiring ESBLs. Antibiotics should be prescribed depending on community acquired infection or hospital acquired infection.
