婴儿大肠埃希菌肺炎临床特点及耐药性分析

临床儿科杂志 ›› 2014, Vol. 32 ›› Issue (3): 228-231.

婴儿大肠埃希菌肺炎临床特点及耐药性分析

刘晟, 张亚丽, 蔡海芳

浙江省丽水市中心医院（浙江丽水　323000）

收稿日期:2013-10-22 出版日期:2014-03-15 发布日期:2014-03-15

Analysis on clinical manifestations and drug resistance of Escherichia coli pneumonia in infants

LIU Sheng, ZHANG Yali, CAI Haifang

(The Central Hospital of Zhejiang Lishui, Lishui 323000, Zhejiang, China)

Received:2013-10-22 Published:2014-03-15 Online:2014-03-15

摘要/Abstract

摘要：

　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。

Abstract: 　Objective　To investigate the clinical features of Escherichia coli pneumonia, the positive rate of extend-spectrum β-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 hospital 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 positive 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.

刘晟, 张亚丽, 蔡海芳. 婴儿大肠埃希菌肺炎临床特点及耐药性分析[J]. 临床儿科杂志, 2014, 32(3): 228-231.

LIU Sheng,ZHANG Yali,CAI Haifang . Analysis on clinical manifestations and drug resistance of Escherichia coli pneumonia in infants[J]. , 2014, 32(3): 228-231.

参考文献

[1] 冯益真. 实用小儿呼吸病学 [M]. 北京：中国协和医科大学出版社，2006：315.
[2] 中华儿科杂志编辑委员会，中华医学会儿科学分会呼吸学组. 全国小儿医院获得性肺炎学术研讨会会议纪要 [J]. 中华儿科杂志，2009，47(12)：960-961.
[3] 中华医学会儿科学会呼吸组,中华儿科杂志编辑委员会. 儿童社区获得性肺炎管理指南(试行)(上) [J]. 中华儿科杂志，2007，45(2)：83-90.
[4] 中华医学会儿科学会呼吸组,中华儿科杂志编辑委员会. 儿童社区获得性肺炎管理指南(试行)(下) [J]. 中华儿科杂志，2007，45（3）：223-230.
[5] 叶应妩，王毓三，申子瑜. 全国临床检验操作规程 [M] . 3版. 南京：东南大学出版社，2006：736-753.
[6] 田庚善. 临床感染病学 [M]. 南京：江苏科学技术出版社，2006：347. .
[7] Maruna P， Nedelníková K, Gürlich R. Physiology and gene-tics of procalcitonin [J]. Physiol Res, 2000,49（Suppl 1）：S57-S6l.
[8] Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects [J]. J Clin Endocrinol Metab，1994,79(6) :1605-1608.
[9] 梁陈方，蒋利君，韦晓谋. 第三代头孢菌素的用药频度与细菌耐药性相关分析 [J]. 柳州医学，2006，19(2)：63-65.
[10] Van Bambeke F, Glupczynski Y, Plésiat P，et al. Antibiotic efflux pumps in prokaryotic cells：occurrence，impact on resistance and strategies for the future of antimicrobial therapy[J]. J Antimicrob Chemother，2003,51(5)：1055-1065.
[11] Kizirgil A, Demirdag K, Ozden M, et al. In vitro activity of three different antimicrobial agents against ESBL producing Escherichia coli and Klebsiella pneumoniae blood isolates[J]. Microbiol Res，2005，160(2)：135-140.