目的　了解儿童重症感染中产超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌（KP）耐药及耐药基因型分布。方 法　收集重症监护病房常规分离的KP，双纸片协同试验进行产ESBLs检测，微量肉汤稀释法进行药敏检测，聚合酶链反 应技术（PCR）检测产ESBLs菌株的耐药基因intl1、acc、ampC、CTX-M1、CTX-M3、DHA1、OXA、shv、tem、NDM、DHA1、 fox、per。 结果　共分离KP?143株，来源以呼吸道标本为主，占81.8%，其中痰标本73.4%。78株产ESBLs?KP对24种 抗 生素呈现不同程度的耐药，氨苄西林、头孢唑啉和哌拉西林的耐药率达100%；氨曲南、头孢曲松和四环素耐药率达 74%以 上； 阿米卡星、多尼培南、厄他培南、美罗培南、替加环素和呋喃妥因敏感率均为100%，检出1株亚胺培南耐药KP 株。 耐 药基因检测显示，DHA1、Shv、Tem、CTX-M1、CTX-M3和Intl1均有不同程度检出，Shv检出率高达87.2%；携带2种、 3 种和4种以上耐药基因的菌株分别占30.7%、62.8%和24.4%。结论　儿童重症感染KP产ESBLs率高，多重耐药模式 复杂。

　Objective? To?understand?the?distribution?of?drug?resistance?and?genotype?of?extended-spectrum?β-lactamase? (ESBL)-producing?Klebsiella pneumoniae?(KP)?in?children?with?severe?infection.?Methods? KP?routinely?separated?in?intensive? care?unit?was?collected,?and?ESBLs?detection?was?conducted?by?double-paper?cooperative?test.?Drug?sensitivity?detection?was? conducted?by?microbroth?dilution?method,?and?drug?resistance?genes?including?intl1,?acc,?ampC,?CTX-M1,?CTX-M3,?DHA1,? OXA,?shv,?tem,?NDM,?DHA1,??fox and per?were?detected?by?polymerase?chain?reaction?(PCR).?Results? A?total?of?143?KP?strains? were?isolated?mainly?from?respiratory?specimens?(81.8%),?73.4%?of?which?were?sputum?specimens.?The?78?strains?of?ESBLs? KP?showed?varying?degrees?of?resistance?to?24?antibiotics,?and?the?rates?of?resistance?to?ampicillin,?cefazolin?and?piperacillin?were? up?to?100%.?The?rate?of?resistance?to?aztreonam,?ceftriaxone?and?tetracycline?were?over?74%.?The?rates?of?sensitivity?to?amikacin,? donipenem,?ertapenem,?meropenem,?tigecycline?and?nitrofurantoin?were?all?100%,?and?one?KP?strain?resistant?to?imipenem?was? detected.?The?drug?resistance?gene?test?showed?that?DHA1,?Shv,?Tem,?CTX-M1,?CTX-M3 and Intl1?were?all?detected?to?varying? degrees,?and?the?detection?rate?of?Shv?was?as?high?as?87.2%.?Strains?with?2,?3?and?≥4??resistant?genes?accounted?for?30.7%,? 62.8%?and?24.4%,?respectively.?Conclusion? The?rate?of?ESBLs?producing?KP?in?severe?infection?children?is?high?and?the? pattern of multidrug resistance is complex.