Fan Panpan, Fu Pan, Liu Jing, Wang Chuanqing, Zhang Xiaolei, Wang Yixue, Zhang Yingying, Zhu Ting, Zhang Caiyan, Lu Guoping, Yan Gangfeng
Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, People's Republic of China.
Lab of Microbiology, Department of Clinical Laboratory, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, People's Republic of China.
Infect Drug Resist. 2024 Sep 23;17:4125-4136. doi: 10.2147/IDR.S475720. eCollection 2024.
To investigate the characteristics and drug resistance patterns of Klebsiella pneumoniae () infection in pediatric intensive care unit (PICU).
strains from 17 domestic PICUs were analyzed for overall condition and drug resistance using WHO-NET software.
From 2016 to 2022, there was a linear increase in the detection rate of (P<0.05), with a total of 2591 (9.7%) strains detected. The primary sites of detection were the respiratory tract (71.1%), blood (8.6%), and urinary tract (7.1%). 's resistance to penicillin drugs exceeded 90%, and are over 50% to cephalosporins. Resistance to cefoperazone-sulbactam decreased from 51.7% to 25.7%, and ranged from 9.1% to 20.8% for ceftolozane-tazobactam. Carbapenem-resistant strains constituted 32.3%. Resistance to imipenem and meropenem have decreased to 33.8% and 40.2%, while increased to 35.2% for ertapenem. Levofloxacin and amikacin resistance rates have decreased to 25.7% and 9.1%, but remain high at 63.8% for moxifloxacin and 44.6% for ciprofloxacin. demonstrated the lowest resistance rates to polymyxin B (0.9%), tigecycline (2.2%), and polymyxin E (3.1%). No strain of was resistant to both polymyxin B and meropenem. However, some strains showed co-resistance to meropenem with other antibiotics, including tigecycline (2%), imipenem (16%), amikacin (27%), colistin (37%), and levofloxacin (41%).
The rates of isolation and drug resistance of in PICU have significantly increased over 7 years. Careful antibiotic use, infection control strategies, and appropriate antibiotic combinations are crucial in addressing this problem.
探讨儿科重症监护病房（PICU）中肺炎克雷伯菌感染的特征及耐药模式。
使用WHO-NET软件对来自17家国内PICU的菌株进行总体情况及耐药性分析。
2016年至2022年，肺炎克雷伯菌的检出率呈线性上升（P<0.05），共检测到2591株（9.7%）。肺炎克雷伯菌的主要检出部位为呼吸道（71.1%）、血液（8.6%）和泌尿道（7.1%）。肺炎克雷伯菌对青霉素类药物的耐药率超过90%，对头孢菌素类药物的耐药率超过50%。对头孢哌酮-舒巴坦的耐药率从51.7%降至25.7%，对头孢他啶-阿维巴坦的耐药率在9.1%至20.8%之间。耐碳青霉烯类肺炎克雷伯菌菌株占32.3%。对亚胺培南和美罗培南的耐药率分别降至33.8%和40.2%，而对厄他培南的耐药率升至35.2%。左氧氟沙星和阿米卡星的耐药率分别降至25.7%和9.1%，但莫西沙星和环丙沙星的耐药率仍较高，分别为63.8%和44.6%。肺炎克雷伯菌对多粘菌素B（0.9%）、替加环素（2.2%）和多粘菌素E（3.1%）的耐药率最低。没有肺炎克雷伯菌菌株对多粘菌素B和美罗培南同时耐药。然而，一些菌株对美罗培南与其他抗生素存在共同耐药，包括替加环素（2%）、亚胺培南（16%）、阿米卡星（27%）、黏菌素（37%）和左氧氟沙星（41%）。
7年来，PICU中肺炎克雷伯菌的分离率和耐药率显著增加。谨慎使用抗生素、感染控制策略及合适的抗生素联合用药对于解决这一问题至关重要。
