中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
5期
277-280
,共4页
刘纯义%金萍%田先雨%招悦%张侃%洪先欧%罗勇
劉純義%金萍%田先雨%招悅%張侃%洪先歐%囉勇
류순의%금평%전선우%초열%장간%홍선구%라용
肺炎克雷白杆菌%重症肺炎%危险因素
肺炎剋雷白桿菌%重癥肺炎%危險因素
폐염극뢰백간균%중증폐염%위험인소
Klebsiella pneumonia%Severe pneumonia%Risk factor
目的 探讨多重耐药肺炎克雷白杆菌重症肺炎的危险因素以及该菌对常用抗菌药物的耐药情况,为防止和减少多重耐药肺炎克雷白杆菌重症肺炎的发生以及合理使用抗生素提供参考依据.方法 采用病例对照研究,选择我院PICU 89例多重耐药肺炎克雷白杆菌重症肺炎患儿作为病例组,选择同期我院PICU 68例非多重耐药肺炎克雷白杆菌重症肺炎患儿作为对照组,对2组患儿的不合理使用抗生素(特别是三代头孢菌素)、住院时间、是否气管插管机械通气、机械通气时间、基础疾病(营养不良、先天性心脏病、遗传代谢病)共5个危险因素进行比较,并对89株多重耐药肺炎克雷白杆菌的药物敏感性进行分析.结果 病例组不合理使用抗生素(特别是三代头孢菌素)病例数(63例,占70.79％)多于对照组(27例,占39.70％),差异有统计学意义(P＜0.01);住院时间＞7d病例数(48例,占53.93％)多于对照组(12例,占17.65％),差异有统计学意义(P＜0.01);气管插管机械通气病例数(38例,占42.69％)多于对照组(16例,占23.53％),差异有统计学意义(P＜0.05);机械通气时间＞5d病例数(18例,占20.22％)多于对照组(5例,占7.35％),差异有统计学意义(P＜0.05);伴有基础疾病病例数(13例,占14.61％)多于对照组(2例,占2.94％),差异有统计学意义(P＜0.05).多重耐药肺炎克雷白杆菌对青霉素类、头孢菌素类、氨基糖苷类以及喹诺酮类抗生素均有较高的耐药率,而对碳青霉烯类抗生素仍保持较高的敏感率.结论 不合理使用抗生素(特别是三代头孢菌素)、住院时间长、气管插管机械通气以及机械通气时间长、原有基础疾病(营养不良、先天性心脏病、遗传代谢病)是多重耐药肺炎克雷白杆菌重症肺炎的重要危险因素;多重耐药肺炎克雷白杆菌对青霉素类、头孢菌素类、氨基糖苷类以及喹诺酮类抗生素均有较高的耐药性,但对碳青霉烯类抗生素仍有较高的敏感性;碳青霉烯类抗生素可以作为治疗多重耐药肺炎克雷白杆菌重症肺炎的首选抗菌药物.
目的 探討多重耐藥肺炎剋雷白桿菌重癥肺炎的危險因素以及該菌對常用抗菌藥物的耐藥情況,為防止和減少多重耐藥肺炎剋雷白桿菌重癥肺炎的髮生以及閤理使用抗生素提供參攷依據.方法 採用病例對照研究,選擇我院PICU 89例多重耐藥肺炎剋雷白桿菌重癥肺炎患兒作為病例組,選擇同期我院PICU 68例非多重耐藥肺炎剋雷白桿菌重癥肺炎患兒作為對照組,對2組患兒的不閤理使用抗生素(特彆是三代頭孢菌素)、住院時間、是否氣管插管機械通氣、機械通氣時間、基礎疾病(營養不良、先天性心髒病、遺傳代謝病)共5箇危險因素進行比較,併對89株多重耐藥肺炎剋雷白桿菌的藥物敏感性進行分析.結果 病例組不閤理使用抗生素(特彆是三代頭孢菌素)病例數(63例,佔70.79％)多于對照組(27例,佔39.70％),差異有統計學意義(P＜0.01);住院時間＞7d病例數(48例,佔53.93％)多于對照組(12例,佔17.65％),差異有統計學意義(P＜0.01);氣管插管機械通氣病例數(38例,佔42.69％)多于對照組(16例,佔23.53％),差異有統計學意義(P＜0.05);機械通氣時間＞5d病例數(18例,佔20.22％)多于對照組(5例,佔7.35％),差異有統計學意義(P＜0.05);伴有基礎疾病病例數(13例,佔14.61％)多于對照組(2例,佔2.94％),差異有統計學意義(P＜0.05).多重耐藥肺炎剋雷白桿菌對青黴素類、頭孢菌素類、氨基糖苷類以及喹諾酮類抗生素均有較高的耐藥率,而對碳青黴烯類抗生素仍保持較高的敏感率.結論 不閤理使用抗生素(特彆是三代頭孢菌素)、住院時間長、氣管插管機械通氣以及機械通氣時間長、原有基礎疾病(營養不良、先天性心髒病、遺傳代謝病)是多重耐藥肺炎剋雷白桿菌重癥肺炎的重要危險因素;多重耐藥肺炎剋雷白桿菌對青黴素類、頭孢菌素類、氨基糖苷類以及喹諾酮類抗生素均有較高的耐藥性,但對碳青黴烯類抗生素仍有較高的敏感性;碳青黴烯類抗生素可以作為治療多重耐藥肺炎剋雷白桿菌重癥肺炎的首選抗菌藥物.
목적 탐토다중내약폐염극뢰백간균중증폐염적위험인소이급해균대상용항균약물적내약정황,위방지화감소다중내약폐염극뢰백간균중증폐염적발생이급합리사용항생소제공삼고의거.방법 채용병례대조연구,선택아원PICU 89례다중내약폐염극뢰백간균중증폐염환인작위병례조,선택동기아원PICU 68례비다중내약폐염극뢰백간균중증폐염환인작위대조조,대2조환인적불합리사용항생소(특별시삼대두포균소)、주원시간、시부기관삽관궤계통기、궤계통기시간、기출질병(영양불량、선천성심장병、유전대사병)공5개위험인소진행비교,병대89주다중내약폐염극뢰백간균적약물민감성진행분석.결과 병례조불합리사용항생소(특별시삼대두포균소)병례수(63례,점70.79％)다우대조조(27례,점39.70％),차이유통계학의의(P＜0.01);주원시간＞7d병례수(48례,점53.93％)다우대조조(12례,점17.65％),차이유통계학의의(P＜0.01);기관삽관궤계통기병례수(38례,점42.69％)다우대조조(16례,점23.53％),차이유통계학의의(P＜0.05);궤계통기시간＞5d병례수(18례,점20.22％)다우대조조(5례,점7.35％),차이유통계학의의(P＜0.05);반유기출질병병례수(13례,점14.61％)다우대조조(2례,점2.94％),차이유통계학의의(P＜0.05).다중내약폐염극뢰백간균대청매소류、두포균소류、안기당감류이급규낙동류항생소균유교고적내약솔,이대탄청매희류항생소잉보지교고적민감솔.결론 불합리사용항생소(특별시삼대두포균소)、주원시간장、기관삽관궤계통기이급궤계통기시간장、원유기출질병(영양불량、선천성심장병、유전대사병)시다중내약폐염극뢰백간균중증폐염적중요위험인소;다중내약폐염극뢰백간균대청매소류、두포균소류、안기당감류이급규낙동류항생소균유교고적내약성,단대탄청매희류항생소잉유교고적민감성;탄청매희류항생소가이작위치료다중내약폐염극뢰백간균중증폐염적수선항균약물.
Objective To explore the risk factors of severe pneumonia caused by multi-drug resistant Klebsiella pneumonia,and antimicrobial drug resistance among these isolates.It may help to prevent and control the disease and promote to rational use of antibiotics.Methods We conducted the case-control study in our PICU.It included 89 patients with severe pneumonia caused by multi-drug resistant Klebsiella pneumonia as case group and 68 patients with severe pneumonia caused by Klebsiella pneumonia as control group during the same period.To compare the two groups on irrationality use of antibiotics (especial for third generation cephalosporin),length of stay,tracheal cannula,time of mechanical ventilation and underlying conditions (malnutrition,congenital heart disease,heredity and metabolic disease).Antimicrobial susceptibilities among 89 multi-drug resistant Klebsiella pneumonia isolates were analyzed.Results There were 63 cases (70.79％) for irrationality use antibiotics in case group,while there were 27 cases (39.70％) in control group (P ＜ 0.01).The cases for length of stay over 7 days in case group (48 cases,53.93％) were more than those cases with the same situation in control group (12 cases,17.65 ％) (P ＜ 0.01).Thirty-eight cases (42.69 ％) needed mechanical ventilation therapy in case group,while 16 cases (23.53％) needed mechanical ventilation therapy in control group (P ＜ 0.01).The cases for duration of mechanical ventilation over 5 days in case group (18 cases,20.22％) were more than those cases in control group (5 cases,7.35％) (P ＜0.05).The cases with underlying disease in case group (13 cases,14.61％) were more than those cases in control group (2 cases,2.94％) (P ＜ 0.05).Multi-drug resistant Klebsiella pneumonia isolates demonstrated that high-level resistance for penicillins,cephalosporins,aminoglycosides and quinolones,but still susceptible to carbapenems.Conclusion Several risk factors are associated with severe pneumonia caused by multi-drug resistant Klebsiella pneumonia,including irrational use of antibiotics (especial for third generation cephalosporin),long term of length of stay,endotracheal intubation,long term of mechanical ventilation,and having underlying disease (malnutrition,congenital heart disease,heredity and metabolic disease).Multi-drug resistant Klebsiella pneumonia isolates demonstrated that high-level resistance for penicillins,cephalosporins,aminoglycosides and quinolones,but still susceptible to Carbapenems.Carbapenems should be used as first-line drugs for severe pneumonia caused by multi-drug resistant Klebsiella pneumonia.
